脓毒症的病理生理学: 从基础到临床
王华东 （暨南大学医学院病理生理学系）
广东省自然科学基金重点项目 国家自然科学基金资助项目
一、脓毒症相关概念的新认识
• Roger Bone and colleagues (1991) :sepsis as a systemic inflammatory response syndrome (SIRS) that can occur during infection (American College of Chest Physicians/Society of Critical Care Medicine).
Sepsis in general surgery (2005-2007 in USA), Arch Surg. 2010;145(7):695-700
Jawad et al. (2012) Assessing available information on the burden of sepsis: global estimates of incidence and mortality
二、脓毒症的流行病学
Mortality of patients with septic shock is still 40%60% in spite of a rapid progress in antibiotics and other therapeutic methods in clinical practice. N Engl J Med 2003;348:1546-54.
• 8 studies reported incidence of sepsis at the national level (4 from the USA and 1 from Brazil, the UK, Norway and Australia). The population sepsis incidence ranged from 149 to 240/100 000 • Case-fatality rate can reach up to 30% for sepsis, 50% for severe sepsis and 80% for septic shock. • No studies on the incidence, mortality or case-fatality from sepsis in developing countries were found.
The definition of Sepsis
Systemic inflammatory response syndrome caused by severe infection, leading to a hyperactive and unbalanced network of inflammatory mediators. Vascular permeability, cardiac function and metabolic balance are affected, resulting in tissue necrosis, multi-organ dysfunction and death.
2001 年底在华盛顿由危重症医学会( SCCM)、 欧洲加强治疗医学会( ESICM)、美国胸科医师协 会(ACCP )、美国胸科协会(ATS)、外科感染学会 ( SIS) 脓毒症概念定义、诊断标准进行重新规定， 同时制定了PIRO脓毒症的分阶段系统 1)一般指标;2)炎症指标;3)血流动力学指标;4) 器官功能障碍参数;5)组织灌流参数。 2005年， 确定儿童脓毒症的诊断标准
Systemic inflammatory response syndrome (SIRS) criteria (≥2 must be
present) • Body temperature>38 ℃ or <36 ℃; • Heart rate >90 beats per minute; • Respiratory rate >20 breaths per minute or PCO2 <32 mmHg; • White blood cell count >12×109/L or <4.0×109/L
Glossary of sepsis (Peter A. Ward, 2012)
• Sepsis: An illness in which the body has a systemic inflammatory response syndrome (SIRS) to bacteria, other pathogens or sterile inflammation (sepsis-like response) • Severe sepsis: Sepsis complicated by end-organ dysfunction, as signalled by altered mental status, hypotension, elevated creatinine concentration or evidence of disseminated intravascular coagulopathy. • Septic shock: Acute circulatory failure induced by sepsis, characterized by persistent arterial hypotension despite adequate fluid resuscitation or by tissue hypoperfusion unexplained by other causes.

Pathogen-associated molecular patterns (PAMPs) and (damage) danger-associated molecular patterns (DAMPs) during sepsis. Peter A. Ward. EMBO Mol Med (2012) 4, 1234–1243