脓毒血症流行病学研究.pdf

1
Epidemiology of Severe
Sepsis and Septic Shock
Arturo Artero1, Rafael Zaragoza2 and José Miguel Nogueira3
1Departments of Internal Medicine
2Intensive Care
3Clinical Microbiology
Hospital Universitario Dr. Peset, Valencia
Departaments of Medicine and Microbiology, Universitat de València
Spain
1. Introduction
Sepsis is defined as bination of pathologic infection and physiological changes
known collectively as the systemic inflammatory response syndrome (Martin, 2003). This
response results in physiological alterations that occur at the capillary endothelial level. In
the early stages, the clinical manifestations of this process are unspecific and it is often
underappreciated in clinical practice. However, early recognition of this syndrome is vital to
reducing mortality in sepsis.
From clinical studies sepsis can be seen as a continuum of severity that begins with an
infection, followed in some cases by sepsis, severe sepsis – an dysfunction – and
septic shock. There has been a substantial increase in the incidence of sepsis during the last
decades, and it appears to be rising over time, with an increasing number of deaths
occurring despite a decline in overall in-hospital mortality (Bone, 1992). Advanced age,
orbidities and number an dysfunction are factors which are
consistently associated with higher mortality in severe sepsis and septic shock.
In this chapter we are going to review the definitions of sepsis syndromes, the factors
that have contributed to the widening of physicians’ awareness of sepsis, severe sepsis
and septic shock; the incidence of severe sepsis and septic shock; the epidemiological
data of patients with severe sepsis and septic shock in the emergency departments and
intensive care units; the causative anisms, and the changes observed over recent
years.
2. Definitions
The concept of sepsis syndrome originated during the time of Hippocrates. But it was not
until the eent