脓毒症和脓毒症休克 Sepsis 3.0 （脓毒症-3.0） 翻译

IMPORTANCE Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.

重要性：重要性脓毒症和脓毒性休克的定义上次在2001年进行了修订。自那时以来，脓毒症的病理生理学（器官功能，形态，细胞生物学，生物化学，免疫学和循环的变化），管理和流行病学方面取得了重大进展，需要重新审查。

OBJECTIVE To evaluate and, as needed, update definitions for sepsis and septic shock.

目标：评估并根据需要更新脓毒症和脓毒性休克的定义。

PROCESS A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic health record databases, and voting, followed by circulation to international professional societies, requesting peer review and endorsement (by 31 societies listed in the Acknowledgment).

过程  由危重病医学学会和欧洲重症监护医学学会共同召集了一个在脓毒症病理生物学，临床试验和流行病学方面具有专业知识的工作组（n = 19）。定义和临床标准通过会议，德尔菲程序，电子健康记录数据库分析和投票生成，随后向国际专业协会发布，请求同行审查和批准（鸣谢中列出的31个社团）。

KEY FINDINGS FROMEVIDENCE SYNTHESIS   Limitations of previous definitions included an excessive focus on inflammation, the misleading model that sepsis follows a continuum through severe sepsis to shock, and inadequate specificity and sensitivity of the systemic inflammatory response syndrome (SIRS) criteria. Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to discrepancies in reported incidence and observed mortality. The task force concluded the term severe sepsis was redundant.

主要合并的调查结果  先前定义的局限性包括对炎症的过度关注，误导性模型是脓毒症通过严重脓毒症到休克的连续过程，以及全身炎症反应综合征（SIRS）标准的特异性和敏感性不足。目前多种定义和术语用于脓毒症，感染性休克和器官功能障碍，导致报告的发病率和观察到的死亡率出现差异。专案组得出结论，重症脓毒症是多余的。

RECOMMENDATIONS Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65mmHg or greater and serum lactate level greater than 2 mmol/L (>18mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%. In out-of-hospital, emergency department, or general hospital ward settings, adult patients with suspected infection can be rapidly identified as being more likely to have poor outcomes typical of sepsis if they have at least 2 of the following clinical criteria that together constitute a new bedside clinical score termed quickSOFA (qSOFA): respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100mmHg or less.

建议  脓毒症应定义为宿主对感染反应失调引起的危及生命的器官功能障碍。对于临床手术，器官功能障碍可表现为序贯性[脓毒症相关]器官衰竭评估（SOFA）评分增加2分或更多，这与院内死亡率大于10％相关。脓毒症性休克应定义为脓毒症的一个亚组，其中特别严重的循环系统，细胞和代谢异常与单纯脓毒症相比，死亡风险更高。脓毒症性休克患者可以通过血管加压剂的要求临床确定，以维持平均动脉压为65mmHg或更高，血清乳酸水平大于2mmol / L（> 18mg / dL），无血容量不足。这种组合与医院死亡率超过40％有关。在院外，急诊科或综合医院病房环境中，疑似感染的成年患者如果至少有以下2种临床标准共同构成，则可能被迅速鉴定为典型脓毒症的预后不良结果一种称为quickSOFA（qSOFA）的新床边临床评分：呼吸频率为22次/分钟或更高，神智改变，或收缩压为100mmHg或更低。

CONCLUSIONS AND RELEVANCE   These updated definitions and clinical criteria should replace previous definitions, offer greater consistency for epidemiologic studies and clinical trials, and facilitate earlier recognition and more timely management of patients with sepsis or at risk of developing sepsis.

结论和相关性  这些更新的定义和临床标准应取代以前的定义，为流行病学研究和临床试验提供更大的一致性，并有助于早期识别和更及时地处理败血症患者或有发生败血症危险的患者。