最近审阅: 八月 2020
最近更新: 十月  2018

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)
更多 首要检查

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
更多 需考虑的检查

新兴检查

  • PhenoTest™ BC 试剂盒
更多 新兴检查

治疗流程

撰稿人

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.

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.

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.

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.

Specialty Registrar in Emergency Medicine

Derriford Hospital

Plymouth

UK

利益声明

EC declares that he has no competing interests.

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.

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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.

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.

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