小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 体温高 (＞38°C) 或者低 (＜36°C)
- 心动过速
- 呼吸急促
- 急性精神状态改变
- 毛细血管再充盈不良、皮肤斑驳或面色苍白
- 特定感染源的体征
- 低血氧饱和度
- 动脉低血压
- 排尿量减少
- 紫绀
其他诊断因素
- 暴发性紫癜
- 黄疸
- 肠梗阻
危险因素
- 潜在恶性肿瘤
- 年龄＞65 岁
- 免疫功能受损
- 血液透析
- 酗酒
- 糖尿病
- 近期手术或其他侵入性操作
- 皮肤完整性破坏
- 留置输液管或导管
- 静脉注射药物滥用
- 妊娠
- 城市居民
- 肺部疾病
- 男性
- 非白人血统
- 冬季
诊断性检查
首要检查
- 全血细胞分类计数
- 血尿素和血清电解质
- 血清肌酐
- 肝功能检测 (LFT)
- 凝血功能检查 (INR，aPTT)
- 血清葡萄糖
- 乳酸水平
- C 反应蛋白 (CRP)
- 血液培养
- 其他培养（例如痰液、粪便、尿液、伤口、导管、假体移植物、硬膜外部位、胸膜或腹膜液）。
- 动脉血气 (ABG) 或静脉血气 (VBG)
- 胸部 X 线检查
- 心电图 (ECG)
需考虑的检查
- 腰椎穿刺术：
- 超声心动图（经胸或经食道）
- 超声检查
- 胸部或腹部 CT
- 血清降钙素原
新兴检查
- PhenoTest™ BC 试剂盒
治疗流程
推测或确诊患有脓毒症
撰稿人
作者
Ron Daniels, MBChB, FRCA
Chief Executive
United Kingdom Sepsis Trust
Chief Executive
Global Sepsis Alliance
Programme Director
Survive Sepsis
Consultant in Critical Care and Anaesthesia
Heart of England NHS Foundation Trust
Birmingham
UK
利益声明
RD has received payment for consultancy on sepsis from Kimal Plc, manufacturers of vascular access devices, from the Northumbria Partnership, a patient safety collaborative, and, where annual leave or other income was compromised in fulfilling his charity duties, from the UK Sepsis Trust. RD has received sponsorship to attend and speak at one meeting from Abbott Diagnostics. He is CEO of the UK Sepsis Trust and Global Sepsis Alliance, and advises HM Government, the World Health Organisation and NHS England on sepsis. Each of these positions demands that he express opinion on strategies around the recognition and management of sepsis.
Matt Inada-Kim, MBBS, FRCP
Consultant Acute Physician & Sepsis Lead
Department of Acute Medicine
Royal Hampshire County Hospital
Hampshire Hospitals NHS Foundation Trust
Winchester
UK
利益声明
MIK is a national clinical advisor on sepsis to NHS England and a national clinical advisor on deterioration to NHS Improvement. He was reimbursed for a slide set by Relias Learning.
Aamir Saifuddin, BMBCh, BA, MRCP, AFFMLM
Specialty Registrar in Gastroenterology and General Medicine
Maidstone and Tunbridge Wells NHS Trust
UK
利益声明
AS is the clinical fellow to the National Medical Director at NHS Improvement. AS has been sponsored on two occasions by Dr Falk Pharma UK to attend specialist gastroenterology conferences abroad; there was no contractual obligation to disseminate product information.
Tim Nutbeam, MSc, Dip IMC FRCEM
Consultant in Emergency Medicine
Clinical Academic
University of Plymouth
Lead Doctor
Devon Air Ambulance Trust
Derriford Hospital
Plymouth
UK
利益声明
TN is a clinical adviser to the UK Sepsis Trust.
Edward Berry, MBChB, MCEM
Specialty Registrar in Emergency Medicine
Derriford Hospital
Plymouth
UK
利益声明
EC declares that he has no competing interests.
鸣谢
Dr Ron Daniels, Dr Matt Inada-Kimand, Dr Aamir Saifuddin, Dr Tim Nutbeam, and Dr Edward Berry would like to gratefully acknowledge Dr Lewys Richmond and Dr Paul Kempen, previous contributors to this topic. LR and PK declare that they have no competing interests.
同行评议者
Steven M. Opal, MD, FIDSA
Professor of Medicine
Infectious Disease Division
Rhode Island Hospital
Alpert Medical School of Brown University
Providence
RI
利益声明
SMO declares that he has no competing interests.
Laura Evans, MD, MSc, FCCP, FCCM
Associate Professor
NYU School of Medicine
Medical Director of Critical Care
Bellevue Hospital Center
New York
NY
利益声明
LE serves as the guidelines co-chair and on the steering committee of the Surviving Sepsis Campaign.
鉴别诊断
- 全身炎症反应综合征 (systemic inflammatory response syndrome, SIRS) 的非感染性病因
- 心肌梗死 (Myocardial infarction, MI)
- 心包炎
更多 鉴别诊断指南
- 糖尿病医学诊疗标准 - 2019
- 2016 年日本脓毒症和脓毒性休克管理的临床实践指南
更多 指南患者教育信息
Sepsis in adults
New leaflet - Cannula insertion
更多 患者教育信息医学计算器
急性生理学与慢性健康状况评分系统 II (APACHE II)
更多 医学计算器Videos
成人诊断性腰椎穿刺的动画演示
气管插管的动画演示
更多 操作视频
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明