Sepsis诊治进展

Sepsis是危重症医学研究的重点课题,1991年8月美国胸科医师协会(ACCP)与美国危重病医学会(SCCM)在芝加哥召开联席会议,共同商讨sepsis及其相关术语的定义,并推荐在今后的临床和基础研究中应用这些新的概念和标准[1]。从此,sepsis的实验和临床研究方兴未艾,对其认识亦日益加深,本文对其进展作一综述。一、Sepsis的流行病学Sepsis存在发病率高、病死率高、治疗费用高的“三高现象”。据统计,sepsis的年发病率达0.3%,全球每年发生的病例数约1800万例,我国尽管尚无确切的统计数据,但推算应该不低于每年400万例。且发病人数现正以每年1.5%的…     

脓毒症与医院感染

脓毒症（Sepsis）是一种常见而又难以诊断和治疗的临床综合征。尽管对重症患者的医护技术在不断改进和发展，国外脓毒症的发病率仍以每年1．5％～8．0％的速度上升，每年严重脓毒症发病率约为0．3％，每年全球超过1800万例。美国每年有70万人患脓毒症，发病率每年增长达8．7％，其中死亡21万，病死率达30％～70％。2002年10月，欧洲加强治疗医学会（ESICM）、     

Sepsis in HIV-positive patients--own observation

In the period of 1988-2001 (June) 24 HIV-positive patients with symptoms of sepsis were observed. Most of them (17 persons) were intravenous drug addicts, six patients were infected HIV trough sexual contact and one person-via blood transfusion. There were 26 cases analyzed (one of the patients went trough three episodes of sepsis). Bacterial sepsis dominated (22 cases). In three patients fungoid etiology was diagnosed, and one case was of mixed character. The highest risk factors of sepsis were: intravenous drug addiction and advanced stage of HIV infection.     

Cutaneous Manifestations of Bacterial Sepsis

Bacterial sepsis is associated with a number of peripheral manifestations involving the skin and soft tissues. In most cases, either a large number of bacteria or an intense inflammatory response by PMNs is present—but not both. The pathogenesis of the lesions is almost certainly multifactorial. Some intriguing observations suggest areas for further investigation.     

基因芯片技术在脓毒症中的应用

基因芯片是近期出现的一项技术，它能够研究基因的表达、寻找新的基因、基因突变检测和多态性检测等，真正体现了基因分析的高通量、小型化、平行化和自动化。本文主要介绍基因芯片在脓毒症中的应用。     

Sepsis associated with transhepatic cholangiography.

A retrospective study was carried out of 74 elderly patients with obstructive jaundice undergoing percutaneous transhepatic cholangiography (PTC) and/or percutaneous biliary drainage (PBD) in order to assess the effect of prophylactic antibiotics on the incidence of fever and sepsis complicating these procedures. Seventeen patients underwent PTC alone, while 57 had both PTC and PBD. Fifty-three patients had either primary or metastatic malignancy. In the other patients with benign disease, choledocholithiasis was the most common reason for undertaking these procedures. Prophylactic antibiotics were given in 80% of cholangiographies and 93% of biliary drainage procedures. There was an overall incidence of sepsis of 13.5%. Enterobacter cloacae and Acinetobacter anitratus were the most common blood culture isolates in patients with malignant biliary obstruction. The incidence of fever was no different between patients who underwent PTC alone compared with those who had PTC and PBD. Of 24 patients who developed fever, two died secondary to sepsis. Although there was no difference in the rate of sepsis and febrile episodes between the two groups, the risk of septic episodes and mortality emphasizes the need for antibiotic prophylaxis and early therapy in elderly patients undergoing percutaneous biliary drainage procedures.     

Bacteroides Sepsis: Diagnosis and Therapy

The clinical setting—such as gynecologic or gastrointestinal surgery—often provides the tipoff that these usually harmless anaerobes are responsible for a life-threatening infection; when the presence of bacteroides is suspected, treatment with appropriate antimicrobials such as chloramphenicol should begin without awaiting confirmation by culture. Even with this approach mortality is likely to be high.