AME证据系列001--转化医学协会:脓毒症诊断和早期识别的临床实践指南

作     者：Zhongheng Zhang Nathan J.Smischney Haibo Zhang Sven Van Poucke Panagiotis Tsirigotis Jordi Rello Patrick M.Honore Win Sen Kuan Juliet June Ray Jiancang Zhou You Shang Yuetian Yu Christian Jung Chiara Robba Fabio Silvio Taccone Pietro Caironi David Grimaldi Stefan Hofer George Dimopoulos Marc Leone Sang-Bum Hong Mabrouk Bahloul Laurent Argaud Won Young Kim Herbert D.Spapen Jose Rodolfo Rocco 张建成(译) 尚游(译) 钟鸣(校) 

作者机构：Department of Emergency MedicineSir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou 310016 Department of Critical Care MedicineJinhua Hospital of Zhejiang UniversityJinhua Zhejiang 321000 Department of AnesthesiologyMayo ClinicRochesterMNUSA Keenan Research Center for Biomedical Science of St.Michael's HospitalDepartments of Anesthesia and PhysiologyInterdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoONCanada Departments of AnesthesiologyCritical CareEmergency Medicine and Pain TherapyZiekenhuis Oost-Limburgy GenkBelgium 2nd Department of Internal MedicineAttikcon University HospitalMedical SchoolNational and Kapodistrian University of AthensAthensGreece CIBERESVall d'Hebron Institut of ResearchUniversitat Autonoma de BarcelonaSpain Universitair Ziekenhuis Brussely Vrije Universiteit Brussel BrusselsBrusselsBelgium Emergency Medicine DepartmentNational University HospitalNational University Health SystemSingapore and the Department of SurgeryYong Loo Lin School of MedicineNational University of SingaporeSingapore DeWitt Daughtry Family Department of SurgeryJackson Memorial HospitalUniversity of Miami Leonard M.Miller School of MedicineMiamiFLUSA Department of Critical Care MedicineSir Run Run Shaw HospitalZhejiang University School of MedicineHangzhou 310016 Department of Critical Care MedicineUnion HospitalTongji Medical CollegueHuazhong University of Science and TechnologyWuhan 430022 Department of Critical Care MedicineRenji HospitalShanghai Jiao Tong University School of MedicineShanghai 200001 University Hospital DusseldorfHeinrich-Heine-University DusseldorfMedical FacultyDivision of CardiologyPulmonology and Vascular MedicineDusseldorfGermany Neurosciences Critical Care UnitAddenbrooke's HospitalCambridgeUK Department of Intensive CareHopital ErasmeUniversite Libre de Bruxelles(ULB)BrusselsBelgium Dipartimento di Fisiopatologia Medico-Chirurgica e dei TrapiantiFondazione IRCCS Ca'Granda-Ospedale Maggiore PoliclinicoUniversity of MilanMilanItaly Intensive Care DepartmentHopital ErasmeUniversite Libre de BruxellesBrusselsBelgium Department of AnesthesiologyUniversity of HeidelbergHeidelbergGermany Department of Critical CareUniversity Hospital ATTIKONMedical SchoolNational and Kapodistrian University of AthensAthensGreece Service d'anesthesie et de reanimationHopital NordAssistance Publique-Hopitaux de MarseilleAix Marseille UniversiteMarseilleFrance Department of Pulmonary and Critical Care MedicineAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea Department of Intensive CareHabib Bourguiba University HospitalSfaxTunisia Medical Intensive Care UnitEdouard Herriot HospitalHospices Civils de Lyonp LyonFrance Department of Emergency MedicineAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea Universitair Ziekenhuis BrusselVrije Universiteit Brussel BrusselsBrusselsBelgium Department of Internal Medicine and Post-graduated ProgramHospital Universitario Clementino Fraga FilhoFederal University of Rio de JaneiroRio de JaneiroBrazil 华中科技大学附属武汉协和医院武汉430022 复旦大学附属中山医院重症医学科上海200032 

出 版 物：《临床与病理杂志》 (Journal of Clinical and Pathological Research)

年 卷 期：2016年第36卷第10期

页      面：1467-1476页

学科分类：100218[医学-急诊医学] 1002[医学-临床医学] 10[医学] 

主　　题：脓毒症 早期识别 诊断 

摘      要：脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。