敗血症/敗血性休克處理策略 Sepsis/Septic shock Management Strategy

Definition 定義
首先先來看看內科聖經Harrison裡對bacteremia, sepsis, septic shock的定義
Bacteremia 菌血症
Presence of bacteria in blood, as evidenced by positive blood cultures
Signs of possibly harmful systemic response
Two or more of the following conditions: (1) fever (oral temperature >38°C [>100.4°F]) or hypothermia (<36°C [<96.8°F]); (2) tachypnea (>24 breaths/min); (3) tachycardia (heart rate >90 beats/min); (4) leukocytosis (>12,000/μL), leukopenia (<4000/μL), or >10% bands
Sepsis (or severe sepsis) 敗血症
The harmful host response to infection; systemic response to proven or suspected infection plus some degree of organ hypofunction, i.e.:
1. Cardiovascular: SBP ≤90 mmHg or MAP ≤70 mmHg that responds to administration of IV fluid
2. Renal: U/O <0.5 mL/kg per hour for 1 h despite adequate fluid resuscitation
3. Respiratory: Pao2/FiO2 ≤250 or, if the lung is the only dysfunctional organ, ≤200
4. Hematologic: Platelet count <80,000/μL or 50% decrease in platelet count from highest value recorded over previous 3 days
5. Unexplained metabolic acidosis: A pH ≤7.30 or a base deficit ≥5.0 mEq/L and a plasma lactate level >1.5 times upper limit of normal for reporting lab
Septic shock 敗血性休克
Sepsis with hypotension (SBP <90 mmHg, or 40 mmHg less than patient’s normal blood pressure) for at least 1 h despite adequate fluid resuscitation or need for vasopressors to maintain SBP ≥90 mmHg or MAP ≥70 mmHg
Refractory septic shock 頑固性敗血性休克
Septic shock that lasts for >1 h and does not respond to fluid or pressor administration

敗血症(Sepsis)是人類宿主對抗病原菌(細菌、黴菌、病毒)產生的一連串全身性發炎反應，包含細胞介質的釋放 、驅使中性球細胞到達感染部位、微血管通透性的增加(使血流可到達感染部位)等等，然而人體過度的發炎反應可能反而造成更嚴重的後果。

敗血症(Severe sepsis已不再獨立出來一個名詞)及嚴重敗血性休克的處理，需要及早的處理。

Treatment 治療與處置

抗生素的使用


Reference: 1. Harrison's Principles of Internal Medicine, 19 edition