NICE 指导建议使用 NEWS2 改善成人脓毒症的风险评估和管理
在对证据进行审查后，英国国家卫生与临床优化研究所（National Institute for Health and Care Excellence, NICE）更新了 16 岁或以上患者脓毒症管理指导。
NICE 建议：
使用 NEWS2（早期预警评分）来评估医院、急性精神卫生机构和救护车中的疑似脓毒症患者。NICE 继续建议在紧急情况下使用 NICE 高风险标准（而不是 NEWS2）对妊娠或近期刚妊娠的患者以及社区或监护机构中的患者进行风险分层。
每次进行新观察或者当病情恶化或出现意外变化时，应重新评估患者的风险等级
如果患者病情没有改善，在采取任何干预措施（抗生素/液体复苏/给氧）后 1 小时内，召集一名高级临床决策者（如英国的 ST3 级医生）亲自到场。
应认识到，如果某单项参数在 NEWS2 评分中占到 3 分，就意味着器官功能障碍和病情进一步恶化的风险增加，这是一个重要的警示信号。
NEWS2 已在英格兰大多数国家医疗服务体系的紧急医疗机构、急诊科、救护车服务和精神卫生机构中使用，因此这些建议旨在进一步提高脓毒症所致急性病识别和应对措施的一致性。
小结
定义
病史和体格检查
关键诊断因素
- 危险因素
- 特定感染源的体征
- 较高的早期预警得分（例如，NEWS2 ≥5 分）
- 呼吸急促（NEWS2）
- 体温偏高或偏低，偶有寒战（NEWS2）
- 心动过速（NEWS2）
- 急性意识状态改变（NEWS2）
- 低血氧饱和度（NEWS2）
- 低血压（NEWS2）
- 少尿
- 毛细血管再充盈不良、皮肤斑驳或面色苍白
- 紫绀
其他诊断因素
- 周身不适/昏睡
- 恶心/呕吐/腹泻
- 暴发性紫癜
- 肠梗阻
- 黄疸
危险因素
- 年龄＞65 岁
- 免疫功能受损
- 留置输液管或导管
- 近期手术或其他侵入性操作
- 血液透析
- 糖尿病
- 静脉注射药物滥用
- 酒精依赖
- 妊娠
- 皮肤完整性破坏
- 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
- 血培养
- 血清乳酸
- 每小时尿量
- 全血细胞计数
- 尿素和电解质（包括肌酐）
- 血清葡萄糖
- C 反应蛋白
- 血清原降钙素
- 凝血筛查
- 肝功能检测
- 血气
- 心电图（ECG）
需考虑的检查
- 尿液分析
- 胸部 X 线检查
- 多来源样本培养
- 腰椎穿刺：
- 计算机断层扫描
- 超声
- 尿抗原检测
- 病毒拭子
- HIV 筛查
- 超声心动图
治疗流程
住院：高度怀疑脓毒症，细菌感染来源未知或不明
社区中：高度怀疑脓毒症，确诊或高度怀疑细菌感染
住院：高度怀疑脓毒症，细菌感染源明确
撰稿人
专家顾问
Alexander Alexiou, MB, BS, BSc, DCH, FRCEM, Dip IMC RCSEd
Emergency Medicine Consultant
Physician Response Unit Consultant
Barts Health NHS Trust
London’s Air Ambulance
Royal London Hospital
London
UK
利益声明
AA declares that he has no competing interests.
Clovis Rau, MBBS, BSc, FRCEM, DipIMC
Specialty Registrar Emergency Medicine (ST6)
Barnet Hospital
Royal Free NHS Foundation Trust
London
UK
利益声明
CR declares that he has no competing interests.
Acknowledgements
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:
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
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
Aamir Saifuddin BMBCh, BA, MRCP, AFFMLM
Specialty Registrar in Gastroenterology and General Medicine
Maidstone and Tunbridge Wells NHS Trust
UK
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
Edward Berry MBChB, MCEM
Specialty Registrar in Emergency Medicine
Derriford Hospital
Plymouth
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 Organization, and NHS England on sepsis. Each of these positions demands that he express opinion on strategies around the recognition and management of sepsis. 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. 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. TN is a clinical adviser to the UK Sepsis Trust. EB declares that he has no competing interests.
同行评议者
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.
编辑
Tannaz Aliabadi-Oglesby
Lead Section Editor, BMJ Best Practice
利益声明
TAO declares that she has no competing interests.
Jo Haynes
Head of Editorial, BMJ Knowledge Centre
利益声明
JH declares that she has no competing interests.
Rachel Wheeler
Lead Section Editor, BMJ Best Practice
利益声明
RW declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
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