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1、2024脓毒症描甯知识要点（全文）脓毒症（Sepsis）是感染引起宿主反应失调，导致危及生命的器官功能损害的症候群，是一个高病死率的临床综合征。微生物-*感染脓毒症脓毒性休克T死亡，这是一个临床逻辑捱。无论是微生物学、感染病学，还是重症医学、呼吸病学等几乎所有的临床亚专业分支，都需要关注脓浜症。一个细节，有翻译SePSiS作“全身性感染”，这显然是不对的。脓毒症概念他血于反应失调、器官功能损害，而非侧垂于感染。而全身性感染对应英文systemicinfection,也不是sepsis11脓毒症的概念经历3次升级。1991年之前，是没有明确定义的时代。199OS是第一代脓毒症概念，sepsis-
2、1=之后经历了SePSiS-2后，2016年JAMA杂志发布了SCPSiS-3的定义，沿用至今。脓毒症领域方一个特殊的情况，定义脓毒症的团体，和实践指南（主要是拯救脓毒症运动指1.2）发布的团体，有时候有不一致。这本质上是发展中问题，大家的认识还不能统一。随着进一步研究的深入，原来问题的答案日益明朗，则会逐渐消弭不同，趋于一致。当然，这时候还会有新的不同。因为脓毒症往往是急症，常常需要快速处理，于是国际文献有一小时集束化处理3、三小时集束化处理的流程。在脓毒症日这样的F1.f里，学习一下既彳的脓毒症指前.PUbMCd中检索（2024.9.13）SePSiSTit1.e,有44953条，可见其热
3、度。左侧Artic1.etype我们选中guide1.ine(注意这是主动标定的指南.有一些指南在登圮时没有标定，这样选中就会漏检)，有68条，亦可见其热度。我们按照检索显示的自然排序，汇报如下：英国NICE的脓毒症指前和总结6。题目：疑似脓毒症：识别、诊断和早期处置美国放射学会(ACR)指南7。题目ACR适当性标准：脓毒症。重症医学学会(SCCM)指南和推荐8,9。题目：2024年焦点更新：关于在脓毒症、急性呼吸窘迫综合征和社区获得性肺炎中使用皮质类固酹激素的指南国际血栓和止血学会科学和标准化武员会指南口0。题目：国际血栓和止血学会科学和标准化委员会关于脓毒症诱导的凝血障碍在脓毒症处置中的沟
4、通。美国胸科学会指南11。题目：脓毒症和急性呼吸窘迫综合征精准医学的研究议程：美国胸科学会官方研究声明。这是研究指南。斯堪的纳维亚麻醉和重症监护医学学会指南12。题目：儿童脓毒性休克和脓毒症相关器官功能障碍处置临床实践指南：斯堪的纳维亚麻醉和重症监护医学学会的认可说这是对SSC指南在儿童领域应用的认可。德国指南13。题目:德国S3指南脓毒症：精选推荐SSC指南14。题目：拯救脓毒症运动：CC)V1.D-19危重成人患者处置指南。(9)SSC指南15。题目：儿童脓毒性休克和脓毒症相关器官功能障碍处置拯救脓毒症运动国际指南。以上是2020后的指南，能够看到美国、英国、德国在这个领域的耕耘,也能看到
5、具体如皮质类固醉激索、凝血等不同的具体话题、儿童领域的应用等。PubMed中检索(2024.9.13)sepsisTit1.cAND(guide1.inesTit1.eORguide1.ineTit1.e1.),有396条。当然这里面包括了对指南的讨论、研究性的文章。其中指南如下:(10)中国儿科领域指南16。题口：美罗培南治疗新生儿脓毒症的临床实践指南丸这是北医三院牵头制定的指南.国际指南”7。题目：成人脓毒症患者静脉注射维生素C治疗：快速实践指南。日本指南18。题目：对脓毒症患者服用维生素C的修订建议：2020年日本脓毒症和脓毒性休克处置临床实践指南。荷丝指南19。题目：2021年荷兰抗生
6、素政策工作组(SWAB)成人脓毒症经验性抗细菌治疗指南。这篇文章的价值很大。(M)SSC指南20。题目：拯救脓毒症运动：2021年脓毒症和脓毒性休克处置国际指南。这说明SSC没有在PubMed里把自己最重要的指南登记为guide1.ineo日本指南21。题目：2020年日本脓毒症和脓毒性休克处置临床实践指南(J-SSCG2020)空无疑问，会有漏检。但上面检索到的文献，足够我们观瞻和学习。西医临床早已经进入到指南医学(本质上就是循证医学)的时代。至少脓毒症领域，此言不虚。NEJM有关于脓毒症指南的综述22,还没有拿到原文。可以关注。近期综述23,也可以关注。UpToDate里脓毒症相关内容，也
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