淺談敗血症及敗血性休克的診斷及治療

Definition and Management of Sepsis and Septic Shock: A Short Review

黃士峰(Shih-Feng Huang) ； 王耀震(Yao-Chen Wang)

《內科學誌》 33卷4期 (2022/08) Pp. 287-297

https://doi.org/10.6314/JIMT.202208_33(4).04

摘要

2016年敗血症指引修改敗血症診斷標準。2021年敗血症指引再度修改診斷標準。考慮到敗血症異質性，沒有完美的準則可以兼顧診斷的敏感度及特異度。指引中包含許多治療建議，然而，所有的敗血症病人都適合用同一套標準治療嗎？本文將簡短回顧敗血症指引的內容，比較新舊版指引間的差異，同時與近年發表的研究結果對照，供讀者參考。敗血症病人異質性高，臨床醫師應針對病人個別狀況，採取對病人最有利的治療策略。

關鍵字

敗血症（Sepsis） ； 敗血性休克（Septic shock）

並列摘要

The most recent guideline from the Surviving Sepsis Campaign was published in 2017, and the use of systemic inflammatory response syndrome was abolished. New definitions may have better specificity but are generally not suitable for every patient. Evidence of treatment recommendations have been low to moderate in quality. Many controversies exist regarding treatment recommendations, such as in the choice of resuscitation fluid and strategy, and the timing of vasopressor initiation. We reviewed some studies published in recent years and compared the difference between the results and guideline recommendations. Due to the high heterogeneity in the sepsis population, individualized treatment may be more beneficial than a protocolized approach.