乌司他丁治疗老年脓毒症性休克的临床研究

目的探讨大剂量乌司他丁对老年脓毒症性休克患者的疗效和安全性。方法选择54例老年脓毒症性休克患者,随机分为对照组和乌司他丁治疗组各27例。对照组按《脓毒血症和脓毒血症性休克治疗指南》予＂集束化＂治疗;乌司他丁治疗组在此基础上再给予乌司他丁120万U（分三次）×10 d。结果 14 d内乌司他丁治疗组的器官衰竭数量低于对照组（P〈0.05）。乌司他丁治疗组14 d的病死率略低于对照组,但无统计学差异。结论大剂量乌司他丁对脓毒症性休克患者具有明显的疗效。     

脓毒血症大鼠肾脏细胞凋亡的变化

目的:研究脓毒血症时肾脏组织细胞凋亡的变化.方法:通过对SD大鼠盲肠结扎及贯穿,建立大鼠的脓毒血症模型,取肾组织制成组织匀浆液.细胞凋亡使用PI/AnnexinV(碘化丙啶/磷脂结合蛋白V)双染色法,用流式细胞仪测定,及通过末端标记(Tunel)技术免疫组织化学法分析细胞凋亡.结果:在SD大鼠脓毒症早期,肾组织细胞凋亡数增加.结论:脓毒血症早期肾组织细胞凋亡数量增加,与细胞因子大量释放有关.     

败血症性休克病人的现代处理:治疗的实验基础

引言严重脓毒血症或败血症性休克病人的处理是一非常困难而棘手的问题。据估计,在住院人数中,死亡率较高的革兰氏阴性菌败血症的发生率可达1%。由于急救护理、临床诊断、抗生素治疗、外科技术、癌症化疗及各种生命维持设备的发展,使更多的人从意外事故、外伤、感染、手术和癌症中获得康复。但是,衰弱的患者易罹感染的可能性依然存在。结果是脓毒血症和/或败血症性休克的病例数似无下降。因此,有必要建立确实有效、可重复的治     

Presepsin (sCD14-ST)与脓毒血症的研究进展

脓毒血症(Sepsis)是一种由感染引起的全身炎症反应综合征(Systemic inflammatory response syndrome, SIRS)，其死亡率高达30%-50%。根据新的脓毒血症治疗指南：早诊断早治疗是提高脓毒血症生存率的关键因素。血培养是诊断脓毒血症的金标准，但其检测周期长。C反应蛋白(C-reactive protein, CRP)和降钙素原(Procalcitonin, PCT)能很好的反映脓毒症病理状态，作为早期诊断脓毒血症标记物在临床上也得到广泛的应用。但其特异性较差，存在假阳性（如重度创伤、烧伤、侵入性手术等也可使血浆CRP和PCT水平升高）。可溶性CD14亚型（soluble CD14 subtype, sCD14-ST）即Presepsin是一种新型的生物标记物，近期研究显示其在脓毒血症的诊断、评价脓疾病严重程度和预后及指导抗菌药物的应用方面起着很好的作用。     

脓毒血症致舒张性心力衰竭的发生机制及处理

脓毒血症是全身严重感染引起的循环病理改变。重症脓毒血症和脓毒性休克患者中,舒张性心力衰竭十分常见,且是死亡率的主要预测因素。脓毒血症诱发的心功能不全可能机制是多种生理反应的结果,包括交感兴奋、细胞因子和ET-1浓度升高以及在细胞水平信号分子的激活。脓毒血症的处理中,要重视对全身的血流动力学的液体复苏和合理的抗感染治疗。     

血清胆红素水平对脓毒血症患者预后的临床意义

<正>报道显示黄疸、肝功能损伤与脓毒血症存在明显的相关性,脓毒血症会诱导胆汁淤积引发高胆红素血症~([1]);其诱导机制可能与微生物分泌产物的毒性及宿主对感染的反应相关。早期也报道了脓毒血症患者会发生高胆红素血症风险。研究发现严重脓毒血症及脓毒症休克患者在72 h内出现胆红素水平的升高,患者死亡率也会随之上升~([2])。脓毒血症患者血清中胆红素及炎性指标明显升高,并且胆红素水平与器官衰竭评分呈明     

D-二聚体与肺部感染

D-二聚体(D-D im er,DD)是在凝血和纤溶异常时出现的,临床上主要用来检测D IC和血栓性疾病。多种疾病包括:严重肝病、肾病综合征、急性胰腺炎、血液病、肿瘤、胶原病和妊娠等都会引起DD水平升高,但这类疾病合并感染后DD水平更高。严重感染或脓毒血症导致全身凝血激活,最终导致纤维蛋白在血管内外沉积[1,2],内毒素血症时引起多种细胞因子释放,细胞因子可刺激组织因子表达,在凝血中发挥中心作用。感染引起DD水平的增高已被普遍接受,但近年来有关肺部感染患者血浆DD水平的变化仍引起了研究者的关注。本文综述了D-二聚体在肺炎和COPD急…     

血清肝素结合蛋白对脓毒症的诊断价值分析

目的:探讨血清肝素结合蛋白(HBP)在脓毒症患者中的诊断价值。方法:选取2016-02—2017-04治疗的脓毒症患者103例,其中脓毒血症患者63例,严重脓毒血症患者40例。同时选取非脓毒血症患者60例和健康志愿者44例作为对照,检测各组HBP、超敏C反应蛋白(hs-CRP)和降钙素原(PCT)水平。结果:脓毒血症组和严重脓毒血症组PCT、HBP和hs-CRP明显高于健康对照组和非脓毒血症组(P0.05);严重脓毒血症组PCT、HBP和hs-CRP明显高于脓毒血症组(P0.05);严重脓毒血症组PCT、HBP和hs-CRP分别为(12.20±1.26)ng/ml、(110.27±40.26)ng/ml和(89.74±13.40)mg/L,明显高于脓毒血症组(P0.05);HBP水平诊断脓毒血症和严重脓毒血症的ROC曲线下面积为0.869和0.922(P0.05),截断值为9.30ng/ml时,其诊断脓毒血症的灵敏度为80.21%,特异度为67.31%,截断值为17.08ng/ml时,其诊断严重脓毒血症的灵敏度为90.00%,特异度为92.00%;脓毒血症和严重脓毒血症患者HBP与PCT呈正相关(r=0.771和0.822,P0.05)。结论:HBP在脓毒症诊断中有较高的价值,且在病情严重程度评估中有一定作用,值得进一步研究。     

重度烧伤患者血清IL-6、IL-10变化及其与脓毒症发生及预后的关系

目的探讨重度烧伤患者血清白细胞介素(IL)-6、IL-10变化及其与脓毒症发生及预后的关系。方法选取2010年11月至2012年12月该院收治的184例烧伤患者,共68例患者并发脓毒血症,并有14例并发脓毒血症患者出现死亡。据此,将184例患者随机分为脓毒血症存活组、脓毒血症死亡组和非脓毒血症组。分别对三组患者的年龄、烧伤总面积以及Ⅲ度烧伤面积进行统计学分析。对所有患者的血清IL-6、IL-10含量进行监测。结果烧伤面积比例以及Ⅲ度烧伤面积比例相比,脓毒血症死亡组明显高于脓毒血症存活组、非脓毒血症组(P<0.05)。严重烧伤后1²0 d三组患者的血清IL-6含量均显著高于正常水平,自伤后第8天开始,脓毒症存活组、脓毒症死亡组的血清IL-6含量明显高于非脓毒血症组;自伤后第13天开始,脓毒症存活组患者的IL-6含量亦出现下降的趋势,而脓毒症死亡组患者的血清IL-6含量一直居高不下,甚至继续增高(P<0.05)。自伤后6 d开始,三组的IL-10含量相比差异具有统计学意义(P<0.05)。结论 IL-6、IL-10作为严重烧伤患者并发脓毒症甚至死亡机制中的重要因素,均可以作为判断严重烧伤预后的重要指标。但IL-10含量监测更适合于烧伤早期,IL-6含量监测更适合于烧伤晚期。     

脓毒血症中的心脏自噬

正脓毒血症是全世界重症监护病房患者的主要死因[1],表现为一种致命的器官功能障碍,由宿主对感染的反应引起[2]。脓毒症已成为一个主要的公共卫生问题,患者常合并慢性并发症,严重降低生活质量并给社会及家庭造成严重影响和负担。目前脓毒症的治疗仍是支持性治疗,大多数基于分子的治疗在临床尝试中都失败了[3,4]。探索新的治疗干预措施以促进这种破坏性临床疾病的治疗,迫在眉睫。心功能不全是脓毒症引起多器官衰竭的一个严重组成部分,过度炎症包括代谢和β-肾上腺素能反应受损被认为是潜在因素[5],脓毒血症引起心肌病的病理生理机制已成为研究的重点。线粒体约占心肌细胞体积的30%[6]。研究表     

Abdominal pain and multi-organ dysfunction syndrome in a young woman

Thyroid storm is a rare but life-threatening condition caused by exaggerated thyrotoxic manifestations. Untreated thyroid storm is fatal, and the case fatality rate is 21% to 30%. The most important clinical management in thyroid storm is early recognition and treatment. We present the case of a previously healthy young woman in whom suspected gastrointestinal tract sepsis complicated by multi-organ dysfunction syndrome masked the major symptomatology of thyroid storm. This patient highlights the importance of a high clinical suspicion for potentially life-threatening conditions, such as thyroid storm, even in the absence of clinical clues (exophthalmos, lid lag, and goiter) or a history of thyrotoxicosis.     

Staphylococcus epidermidis as a rare cause of sepsis

Implanted synthetic materials have to be included into the differential diagnosis of sepsis. This paper reports on a case of sepsis caused by Staphylococcus epidermidis in connection with a Spitz-Holter shunt. The interval between the implantation and the recognition of the endoplastitis took 4 years. The attempt of an antibiotic sanitation had no results. The fitness for work could be restored by removal of the shunt and reimplantation.     

Niere und Sepsis

Sepsis is often characterized by end-organ dysfunction distant from the primary site of infection. Acute kidney injury (AKI) occurs in more than 50% of patients with sepsis or septic shock and is associated with a very high mortality of 30?C70%. The occurrence of AKI represents an independent predictor for this high mortality in sepsis. In contrast AKI is an important risk factor for the development of sepsis. Not only renal ischemia and tubular necrosis but also redistribution of an increased renal blood flow, increased intrarenal pressure caused by interstitial and extrarenal edema and mechanisms of inflammation with subsequent tubular apoptosis play major roles in the pathogenesis of AKI. Early recognition, early targeted hemodynamic therapy with crystalloids and vasopressors, as well as avoidance of nephrotoxic substances are important factors in prevention and therapy of AKI. Moreover, it is also very important to avoid overhydration.     

The Resuscitation Package in Sepsis

Sepsis and its attendant complications are commonly encountered in the intensive care unit. Early recognition of sepsis is critical because it allows for rapid deployment of a multifaceted resuscitation package. The cornerstones of sepsis management are antibiotic therapy, source control, and hemodynamic resuscitation. In select patients, ancillary therapies are indicated, such as activated protein C, corticosteroids, and glycemic control. Given the complexity of sepsis management, optimal care can be delivered as a bundle—a protocol encompassing the above interventions. The evidence behind the various components of sepsis management are reviewed here.     

Immunoprophylaxis and immunotherapy of gram-negative sepsis and shock with antibodies to core glycolipids and lipid a of bacterial lipopolysaccharides

Conclusions The results obtained by numerous investigators reveal the ability of antibodies to cross-reactive LPS antigens to protect against infections caused by various gram-negative pathogens and their endotoxins. Based upon experimental and clinical experience, one could postulate that these antibodies are a promising approach for the prophylaxis and therapy of sepsis. The recognition of high-risk patients would allow early start of combined therapy with appropriate immune preparations and antibiotics, which along with life-supporting measures (corticosteroids, electrolyte and nutrition infusions, etc.), would be a useful tool in the treatment of gram-negative sepsis and endotoxin shock.     

Sepsis and septic shock: current approaches to management

Sepsis, defined as life‐threatening organ dysfunction due to a dysregulated host response to infection, is recognised by the World Health Organization as a global health priority. Each year, 5000 of the 18 000 adults with sepsis treated in Australian intensive care units die, with survivors suffering long‐term physical, cognitive and psychological dysfunction, which is poorly recognised and frequently untreated. There are currently no effective pharmacological treatments for sepsis, making early recognition, resuscitation and immediate treatment with appropriate antibiotics the key to reducing the burden of resulting disease. The majority of sepsis, around 70–80%, is community acquired making emergency departments and primary care key targets to improve recognition and early management. Case fatality rates for sepsis are decreasing in many countries with the reduction attributed to national or regional screening and quality improvement programmes focused on early identification and immediate treatment. The optimum approach to treating established sepsis has been informed by high‐quality, multicentre investigator initiated randomised trials with much of the valuable data coming from National Health and Medical Research Council‐funded trials run from Australia. While early recognition and improved management of the acute episode are important steps in reducing death and disability from sepsis, a substantial reduction in the burden of sepsis‐related disease requires action across the entire healthcare system. In this narrative review, we provide a summary of current knowledge on epidemiology of sepsis and septic shock and recommendations on the optimum approach to the management of these conditions in adults.     

Jaundice and the sepsis syndrome: a neglected link

The relationship between the sepsis syndrome and the development of jaundice is intriguing, with jaundice having been described as the presenting sign of septicaemia in very few cases. We describe a patient who developed a deep jaundice with conjugated hyperbilirubinaemia caused by Staphylococcus aureus during the early course of septicaemia, when no other sign of the sepsis syndrome could be recognised. It is generally accepted that a mild jaundice may complicate the course of the sepsis syndrome, but it is most unusual to observe such a protracted phase of jaundice before the emergence of other specific clinical signs and laboratory abnormalities. Clinicians should be aware of this presentation of the sepsis syndrome in order to avoid a potentially harmful delay in diagnosis and treatment.     

Novel biomarkers for sepsis: A narrative review

BackgroundSepsis is a prevalent condition among hospitalized patients that carries a high risk of morbidity and mortality. Rapid recognition of sepsis as the cause of deterioration is desirable, so effective treatment can be initiated rapidly. Traditionally, diagnosis was based on presence of two or more positive SIRS criteria due to infection. However, recently published sepsis-3 criteria put more emphasis on organ dysfunction caused by infection in the definition of sepsis. Regardless of this, no gold standard for diagnosis exist, and clinicians still rely on a number of traditional and novel biomarkers to discriminate between patients with and without infection, as the cause of deterioration.MethodNarrative review of current literature.ResultsA number of the most promising biomarkers for diagnoses and prognostication of sepsis are presented.ConclusionProcalcitonin, presepsin, CD64, suPAR, and sTREM-1 are the best evaluated biomarkers for diagnosis and prognostication of sepsis to date. All have limitations in differentiation between infected and non-infected patients with SIRS, and their future role in diagnosis needs to be evaluated. It is important to test utility, performance, and validity of future biomarkers before implementing them in routine clinical care.     

The emergence of coryneform bacteria as a cause of nosocomial infections in compromised hosts

Corynebacterium species that are normally abundant on the skin and mucous membranes rarely cause infections and are susceptible to most antibiotics. The report in 1976 of four cases of sepsis at the National Institutes of Health caused by a hitherto undescribed Corynebacterium that is highly antibiotic resistant, but uniformly susceptible to vancomycin, alerted the medically oriented scientific community to the emergence of these organisms as a possible new cause of nosocomial infections. Although we have always performed antibiotic susceptibility tests on all microorganisms recovered from normally sterile body fluids, our first recovery of these organisms was in August 1977. Since then we have recovered 52 such strains from 39 patients, most frequently from the rectum, followed by the groin, blood, lesions and urine in order of predominance. Characterization by API 50 L strips revealed that most, but not all strains resemble the JK group of Riley et al. [1]. Cell wall studies and DNA base ratios further confirmed their status as corynebacteria. Hospital acquisition has been proved; cross infection between patients is the most likely mode of spread. Their recognition is necessary for optimal preventive and therapeutic care of patients with compromised host defenses.