小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 发热或体温低
- 呼吸急促
- 心动过速
- 心动过缓（新生儿和婴儿）
- 精神状态或行为改变
- 外周灌注下降
- 新生儿中活动或喂养模式变化
- 尿片干/尿排出量减少
- 皮肤斑驳、面色苍白、发绀
- 低血氧饱和度
- 血管麻痹
- 按压不退色的紫癜样皮疹
其他诊断因素
- 低血压
- 反映基础病变特定的局灶性体征和症状
危险因素
- 免疫缺陷
- 合并症
- 男性
- 较小的年龄（尤其是新生儿）
- 围产期感染危险因素（新生儿）
- 保健相关因素（新生儿）
- 近期手术或其他侵入性操作
- 皮肤完整性破坏
诊断性检查
首要检查
- FBC 和分类计数
- 血清葡萄糖
- 血培养
- 尿液分析
- 尿液培养
- 血气
- 血清乳酸
- 血清电解质
- 血清肌酐
- 肝功能检查 (LFT)
- 凝血功能检查
- C 反应蛋白 (CRP)
- 胸部 X 线检查
需考虑的检查
- 腰椎穿刺：
- 脑膜炎球菌聚合酶链反应分析
- 支气管肺泡灌洗培养
- 单纯疱疹病毒（herpes simplex virus, HSV）聚合酶链反应（血液和脑脊液）
新兴检查
- 血清原降钙素
- 新出现的生物标志物
- PhenoTest™ BC 试剂盒
治疗流程
推测或确诊患有脓毒症
撰稿人
作者
Akash Deep, MD, FRCPCH
Director and Professor of Paediatric Critical Care
Paediatric Intensive Care Unit
King’s College Hospital
London
UK
利益声明
AD declares that he has no competing interests.
Chris Duncan, BMBS, BMedSci, MRCP, FFICM, FEWM, RMP, PGCert
Professorial Fellow
Intensive Care Medicine
Nepean Hospital
Sydney
Australia
利益声明
CD declares that he has no competing interests.
鸣谢
Dr Akash Deep and Dr Chris Duncan would like to gratefully acknowledge Dr Jeremy Tong and Dr Adrian Plunkett, previous contributors to this topic.
利益声明
JT and AP are authors involved in the Paediatric Sepsis Six initiative, cited in this topic.
同行评议者
Saul N. Faust, MA, MBBS, FRCPCH, PhD, FHEA
Professor of Paediatric Immunology & Infectious Diseases
Director, NIHR Wellcome Trust Clinical Research Facility
University of Southampton
Southampton
UK
利益声明
SNF declares that he has no competing interests.
Mohan Pammi, MBBS, MD, MRCPCH
Assistant Professor
Texas Children's Hospital and Baylor College of Medicine
Houston
TX
利益声明
MP declares that he has no competing interests.
Jerry J. Zimmerman, MD, PhD
Faculty, Pediatric Critical Care Medicine
Seattle Children's Hospital
University of Washington School of Medicine
Seattle
WA
利益声明
JJZ receives research grant support from NIH/NICHD and ImmuneXpress; travel reimbursement from the Society of Critical Care Medicine to attend board meetings; and royalties from Elsevier for action as a co-editor for the textbook Pediatric Critical Care.
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