尿源性脓毒血症的治疗进展
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摘要
脓毒血症是机体对外来炎症因子反应失调引起的全身炎症反应综合征,尿源性脓毒血症主要是由泌尿系梗阻感染所致,主要致病物质为脂多糖。随着医学技术的不断进步,尿源性脓毒血症的病死率有所下降。其主要治疗原则为及早去除病因,早发现、早诊断、早治疗。提早液体复苏、抗菌药物及糖皮质激素的使用能降低患者病死率,但目前针对尿源性浓度血症患者糖皮质激素的使用仍存在争议。尿源性脓毒血症治疗的主要目的在于降低患者病死率,改善预后,防治相关并发症。
Sepsis is a systemic inflammatory response syndrome caused by the imbalance of the body' s response to foreign inflammatory factors. Urosepsis is mainly caused by urinary tract obstruction infection,and the main pathogenic substance is lipopolysaccharide. With the development of medical technology,the mortality of urosepsis has decreased. Its main treatment principles are early removal of causes,early detection,early diagnosis,and early treatment. The use of early fluid resuscitation,antimicrobial agents and glucocorticoids can reduce the mortality of the patients,but the use of glucocorticoids in patients with urinary concentration-induced hypertension is still controversial. The main purpose of the treatment is to reduce the mortality,improve the prognosis and prevent related complications.
Sepsis is a systemic inflammatory response syndrome caused by the imbalance of the body' s response to foreign inflammatory factors. Urosepsis is mainly caused by urinary tract obstruction infection,and the main pathogenic substance is lipopolysaccharide. With the development of medical technology,the mortality of urosepsis has decreased. Its main treatment principles are early removal of causes,early detection,early diagnosis,and early treatment. The use of early fluid resuscitation,antimicrobial agents and glucocorticoids can reduce the mortality of the patients,but the use of glucocorticoids in patients with urinary concentration-induced hypertension is still controversial. The main purpose of the treatment is to reduce the mortality,improve the prognosis and prevent related complications.
引文
[1]Singer M,Deutschman CS,Seymour CW,et al.The Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
[2]Rhodes A,Evans LE,Alhazzani W,et al.Surviving Sepsis Campaign:International Guidelines for Management of Sepsis and Septic Shock:2016[J].Crit Care Med,2017,45(3):486-552.
[3]Prescott HC,Angus DC.Enhancing Recovery From Sepsis:AReview[J].JAMA,2018,319(1):62-75.
[4]Wagenlehner FM,Tandogdu Z,Bjerklund Johansen TE.An update on classification and management of urosepsis[J].Curr Opin Urol,2017,27(2):133-137.
[5]López-Banda DA,Carrillo-Casas EM,Leyva-Leyva M,et al.Identification of virulence factors genes in Escherichia coli isolates from women with urinary tract infection in Mexico[J].Biomed Res Int,2014,2014:959206.
[6]Wagenlehner FM,Lichtenstern C,Rolfes C,et al.Diagnosis and management for urosepsis[J].Int J Urol,2013,20(10):963-970.
[7]Jimenez-Alcaide E,Medina-Polo J,Garcia-Gonzalez L,et al.Healthcare-associated urinary tract infections in patients with a urinary catheter:Risk factors,microbiological characteristics and patterns of antibiotic resistance[J].Arch Esp Urol,2015,68(6):541-550.
[8]Barber AE,Norton JP,Wiles TJ,et al.Strengths and Limitations of Model Systems for the Study of Urinary Tract Infections and Related Pathologies[J].Microbiol Mol Biol Rev,2016,80(2):351-367.
[9]Cheng Y,Li X,Tse HF,et al.Gallic Acid-L-Leucine Conjugate Protects Mice against LPS-Induced Inflammation and Sepsis via Correcting Proinflammatory Lipid Mediator Profiles and Oxidative Stress[J].Oxid Med Cell Longev,2018,2018:1081287.
[10]Wu Y.The plasma contact system as a modulator of innate immunity[J].Curr Opin Hematol,2018,25(5):389-394.
[11]Armstrong BA,Betzold RD,May AK.Sepsis and Septic Shock Strategies[J].Surg Clin North Am,2017,97(6):1339-1379.
[12]Wagenlehner FME,Pilatz A,Weidner W,et al.Urosepsis:Overview of the Diagnostic and Treatment Challenges[J].Microbiol Spectr,2015,3(5).
[13]Reyner K,Heffner AC,Karvetski CH.Urinary obstruction is an important complicating factor in patients with septic shock due to urinary infection[J].Am J Emerg Med,2016,34(4):694-696.
[14]Shen J,Sun F,Chen FM,et al.Therapy and Prevention of Postoperative Urosepsis of Ureter Endoscopic Lithotripsy for"Noninfection"[J].Chin Med Sci J,2016,31(1):49-53.
[15]Cosic I,Cosic V.Complicated urinary tract infections in the elderly[J].Acta Med Croatica,2016,70(4/5):249-255.
[16]Lee DS,Choe HS,Kim HY,et al.Acute bacterial prostatitis and abscess formation[J].BMC Urol,2016,16(1):38.
[17]Alkhateeb SS,Alshammari NA,Alzughaibi MA,et al.The prevalence of urinary tract infection,or urosepsis following transrectal ultrasound-guided prostate biopsy in a subset of the Saudi population and patterns of susceptibility to flouroquinolones[J].Saudi Med J,2016,37(8):860-863.
[18]Rud O,Morsler J,Peter J,et al.A non-abscess-forming inflammation of the corpora cavernosa in a diabetic patient-case report[J].Aktuelle Urol,2010,41(5):323-325.
[19]Dreger NM,Degener S,Ahmad-Nejad P,et al.Urosepsis-Etiology,Diagnosis,and Treatment[J].Dtsch Arztebl Int,2015,112(49):837-847.
[20]Chennamsetty A,Khourdaji I,Burks F,et al.Contemporary diagnosis and management of Fournier's gangrene[J].Ther Adv Urol,2015,7(4):203-215.
[21]Vazquez-Grande G,Kumar A.Optimizing antimicrobial therapy of sepsis and septic shock:Focus on antibiotic combination therapy[J].Semin Respir Crit Care Med,2015,36(1):154-166.
[22]Whiles BB,Deis AS,Simpson SQ.Increased Time to Initial Antimicrobial Administration Is Associated With Progression to Septic Shock in Severe Sepsis Patients[J].Crit Care Med,2017,45(4):623-629.
[23]Gao L,Liu X,Zhang D,et al.Early diagnosis of bacterial infection in patients with septicopyemia by laboratory analysis of PCT,CRPand IL-6[J].Exp Ther Med,2017,13(6):3479-3483.
[24]Zheng J,Li Q,Fu W,et al.Procalcitonin as an early diagnostic and monitoring tool in urosepsis following percutaneous nephrolithotomy[J].Urolithiasis,2015,43(1):41-47.
[25]Cabrera JL,Pinsky MR.Management of septic shock:A protocolless approach[J].Crit Care,2015,19:260.
[26]Winters ME,Sherwin R,Vilke GM,et al.What is the Preferred Resuscitation Fluid for Patients with Severe Sepsis and Septic Shock?[J].J Emerg Med,2017,53(6):928-939.
[27]Taeb AM,Hooper MH,Marik PE.Sepsis:Current Definition,Pathophysiology,Diagnosis,and Management[J].Nutr Clin Pract,2017,32(3):296-308.
[28]Marik P,Bellomo R.A rational approach to fluid therapy in sepsis[J].Br J Anaesth,2016,116(3):339-349.
[29]Cecconi M,De Backer D,Antonelli M,et al.Consensus on circulatory shock and hemodynamic monitoring.Task force of the European Society of Intensive Care Medicine[J].Intensive Care Med,2014,40(12):1795-1815.
[30]Gu WJ,Zhang Z,Bakker J.Early lactate clearance-guided therapy in patients with sepsis:A meta-analysis with trial sequential analysis of randomized controlled trials[J].Intensive Care Med,2015,41(10):1862-1863.
[31]Wang B,Jiang J,Yang J,et al.Pharmacologic studies on ET-26hydrochloride in a rat model of lipopolysaccharide-induced sepsis[J].Eur J Pharm Sci,2017,109:441-445.
[32]Keh D,Trips E,Marx G,et al.Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis:The HYPRESSRandomized Clinical Trial[J].JAMA,2016,316(17):1775-1785.
[33]Heming N,Sivanandamoorthy S,Meng P,et al.Immune Effects of Corticosteroids in Sepsis[J].Front Immunol,2018,9:1736.
[34]Volbeda M,Wetterslev J,Gluud C,et al.Glucocorticosteroids for sepsis:Systematic review with meta-analysis and trial sequential analysis[J].Intensive Care Med,2015,41(7):1220-1234.
[35]Zhou J,Chaudhry H,Zhong Y,et al.Dysregulation in microRNAexpression in peripheral blood mononuclear cells of sepsis patients is associated with immunopathology[J].Cytokine,2015,71(1):89-100.
[36]Venet F,Monneret G.Advances in the understanding and treatment of sepsis-induced immunosuppression[J].Nat Rev Nephrol,2018,14(2):121-137.
[37]Liu Q,Li CS.Programmed Cell Death-1/Programmed Deathligand 1 Pathway:A New Target for Sepsis[J].Chin Med Engl,2017,130(8):986-992.
[38]Patil NK,Guo Y,Luan L,et al.Targeting Immune Cell Checkpoints during Sepsis[J].Int J Mol Sci,2017,18(11).pii:E2413.
[39]Francisco-Cruz A,Aguilar-Santelises M,Ramos-Espinosa O,et al.Granulocyte-macrophage colony-stimulating factor:Not just another haematopoietic growth factor[J].Med Oncol,2014,31(1):774.
[40]Delano MJ,Ward PA.Sepsis-induced immune dysfunction:Can immune therapies reduce mortality?[J].J Clin Invest,2016,126(1):23-31.
[41]Karnad DR,Bhadade R,Verma PK,et al.Intravenous administration of ulinastatin(human urinary trypsin inhibitor)in severe sepsis:Amulticenter randomized controlled study[J].Intensive Care Med,2014,40(6):830-838.
[42]Gotts JE,Matthay MA.Sepsis:Pathophysiology and clinical management[J].BMJ,2016,53:i1585.
[43]Zhang Z.Recombinant human activated protein C for the treatment of severe sepsis and septic shock:A study protocol for incorporating observational evidence using a Bayesian approach[J].BMJ Open,2014,4(7):e005622.
[44]Levy MM,Rhodes A,Phillips GS,et al.Surviving Sepsis Campaign:Association between performance metrics and outcomes in a7.5-year study[J].Crit Care Med,2015,43(1):3-12.
[45]Marik PE,Khangoora V,Rivera R,et al.Hydrocortisone,Vitamin C,and Thiamine for the Treatment of Severe Sepsis and Septic Shock:A Retrospective Before-After Study[J].Chest,2017,151(6):1229-1238.
[46]Marik PE.Vitamin C for the treatment of sepsis:The scientific rationale[J].Pharmacol Ther,2018,189:63-70.
[47]Steeland S,Libert C,Vandenbroucke RE.A New Venue of TNFTargeting[J].Int J Mol Sci,2018,19(5).pii:E1442.
[48]Poli EC,RimmeléT,Schneider AG.Hemoadsorption with CytoSorb~? [J].Intensive Care Med,2019,45(2):236-239.
[49]Poli EC,Simoni C,Andre P,et al.Clindamycin clearance during Cytosorb~? hemoadsorption:A case report and pharmacokinetic study[J].Int J Artif Organs,2019 42(4):190-193.
[2]Rhodes A,Evans LE,Alhazzani W,et al.Surviving Sepsis Campaign:International Guidelines for Management of Sepsis and Septic Shock:2016[J].Crit Care Med,2017,45(3):486-552.
[3]Prescott HC,Angus DC.Enhancing Recovery From Sepsis:AReview[J].JAMA,2018,319(1):62-75.
[4]Wagenlehner FM,Tandogdu Z,Bjerklund Johansen TE.An update on classification and management of urosepsis[J].Curr Opin Urol,2017,27(2):133-137.
[5]López-Banda DA,Carrillo-Casas EM,Leyva-Leyva M,et al.Identification of virulence factors genes in Escherichia coli isolates from women with urinary tract infection in Mexico[J].Biomed Res Int,2014,2014:959206.
[6]Wagenlehner FM,Lichtenstern C,Rolfes C,et al.Diagnosis and management for urosepsis[J].Int J Urol,2013,20(10):963-970.
[7]Jimenez-Alcaide E,Medina-Polo J,Garcia-Gonzalez L,et al.Healthcare-associated urinary tract infections in patients with a urinary catheter:Risk factors,microbiological characteristics and patterns of antibiotic resistance[J].Arch Esp Urol,2015,68(6):541-550.
[8]Barber AE,Norton JP,Wiles TJ,et al.Strengths and Limitations of Model Systems for the Study of Urinary Tract Infections and Related Pathologies[J].Microbiol Mol Biol Rev,2016,80(2):351-367.
[9]Cheng Y,Li X,Tse HF,et al.Gallic Acid-L-Leucine Conjugate Protects Mice against LPS-Induced Inflammation and Sepsis via Correcting Proinflammatory Lipid Mediator Profiles and Oxidative Stress[J].Oxid Med Cell Longev,2018,2018:1081287.
[10]Wu Y.The plasma contact system as a modulator of innate immunity[J].Curr Opin Hematol,2018,25(5):389-394.
[11]Armstrong BA,Betzold RD,May AK.Sepsis and Septic Shock Strategies[J].Surg Clin North Am,2017,97(6):1339-1379.
[12]Wagenlehner FME,Pilatz A,Weidner W,et al.Urosepsis:Overview of the Diagnostic and Treatment Challenges[J].Microbiol Spectr,2015,3(5).
[13]Reyner K,Heffner AC,Karvetski CH.Urinary obstruction is an important complicating factor in patients with septic shock due to urinary infection[J].Am J Emerg Med,2016,34(4):694-696.
[14]Shen J,Sun F,Chen FM,et al.Therapy and Prevention of Postoperative Urosepsis of Ureter Endoscopic Lithotripsy for"Noninfection"[J].Chin Med Sci J,2016,31(1):49-53.
[15]Cosic I,Cosic V.Complicated urinary tract infections in the elderly[J].Acta Med Croatica,2016,70(4/5):249-255.
[16]Lee DS,Choe HS,Kim HY,et al.Acute bacterial prostatitis and abscess formation[J].BMC Urol,2016,16(1):38.
[17]Alkhateeb SS,Alshammari NA,Alzughaibi MA,et al.The prevalence of urinary tract infection,or urosepsis following transrectal ultrasound-guided prostate biopsy in a subset of the Saudi population and patterns of susceptibility to flouroquinolones[J].Saudi Med J,2016,37(8):860-863.
[18]Rud O,Morsler J,Peter J,et al.A non-abscess-forming inflammation of the corpora cavernosa in a diabetic patient-case report[J].Aktuelle Urol,2010,41(5):323-325.
[19]Dreger NM,Degener S,Ahmad-Nejad P,et al.Urosepsis-Etiology,Diagnosis,and Treatment[J].Dtsch Arztebl Int,2015,112(49):837-847.
[20]Chennamsetty A,Khourdaji I,Burks F,et al.Contemporary diagnosis and management of Fournier's gangrene[J].Ther Adv Urol,2015,7(4):203-215.
[21]Vazquez-Grande G,Kumar A.Optimizing antimicrobial therapy of sepsis and septic shock:Focus on antibiotic combination therapy[J].Semin Respir Crit Care Med,2015,36(1):154-166.
[22]Whiles BB,Deis AS,Simpson SQ.Increased Time to Initial Antimicrobial Administration Is Associated With Progression to Septic Shock in Severe Sepsis Patients[J].Crit Care Med,2017,45(4):623-629.
[23]Gao L,Liu X,Zhang D,et al.Early diagnosis of bacterial infection in patients with septicopyemia by laboratory analysis of PCT,CRPand IL-6[J].Exp Ther Med,2017,13(6):3479-3483.
[24]Zheng J,Li Q,Fu W,et al.Procalcitonin as an early diagnostic and monitoring tool in urosepsis following percutaneous nephrolithotomy[J].Urolithiasis,2015,43(1):41-47.
[25]Cabrera JL,Pinsky MR.Management of septic shock:A protocolless approach[J].Crit Care,2015,19:260.
[26]Winters ME,Sherwin R,Vilke GM,et al.What is the Preferred Resuscitation Fluid for Patients with Severe Sepsis and Septic Shock?[J].J Emerg Med,2017,53(6):928-939.
[27]Taeb AM,Hooper MH,Marik PE.Sepsis:Current Definition,Pathophysiology,Diagnosis,and Management[J].Nutr Clin Pract,2017,32(3):296-308.
[28]Marik P,Bellomo R.A rational approach to fluid therapy in sepsis[J].Br J Anaesth,2016,116(3):339-349.
[29]Cecconi M,De Backer D,Antonelli M,et al.Consensus on circulatory shock and hemodynamic monitoring.Task force of the European Society of Intensive Care Medicine[J].Intensive Care Med,2014,40(12):1795-1815.
[30]Gu WJ,Zhang Z,Bakker J.Early lactate clearance-guided therapy in patients with sepsis:A meta-analysis with trial sequential analysis of randomized controlled trials[J].Intensive Care Med,2015,41(10):1862-1863.
[31]Wang B,Jiang J,Yang J,et al.Pharmacologic studies on ET-26hydrochloride in a rat model of lipopolysaccharide-induced sepsis[J].Eur J Pharm Sci,2017,109:441-445.
[32]Keh D,Trips E,Marx G,et al.Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis:The HYPRESSRandomized Clinical Trial[J].JAMA,2016,316(17):1775-1785.
[33]Heming N,Sivanandamoorthy S,Meng P,et al.Immune Effects of Corticosteroids in Sepsis[J].Front Immunol,2018,9:1736.
[34]Volbeda M,Wetterslev J,Gluud C,et al.Glucocorticosteroids for sepsis:Systematic review with meta-analysis and trial sequential analysis[J].Intensive Care Med,2015,41(7):1220-1234.
[35]Zhou J,Chaudhry H,Zhong Y,et al.Dysregulation in microRNAexpression in peripheral blood mononuclear cells of sepsis patients is associated with immunopathology[J].Cytokine,2015,71(1):89-100.
[36]Venet F,Monneret G.Advances in the understanding and treatment of sepsis-induced immunosuppression[J].Nat Rev Nephrol,2018,14(2):121-137.
[37]Liu Q,Li CS.Programmed Cell Death-1/Programmed Deathligand 1 Pathway:A New Target for Sepsis[J].Chin Med Engl,2017,130(8):986-992.
[38]Patil NK,Guo Y,Luan L,et al.Targeting Immune Cell Checkpoints during Sepsis[J].Int J Mol Sci,2017,18(11).pii:E2413.
[39]Francisco-Cruz A,Aguilar-Santelises M,Ramos-Espinosa O,et al.Granulocyte-macrophage colony-stimulating factor:Not just another haematopoietic growth factor[J].Med Oncol,2014,31(1):774.
[40]Delano MJ,Ward PA.Sepsis-induced immune dysfunction:Can immune therapies reduce mortality?[J].J Clin Invest,2016,126(1):23-31.
[41]Karnad DR,Bhadade R,Verma PK,et al.Intravenous administration of ulinastatin(human urinary trypsin inhibitor)in severe sepsis:Amulticenter randomized controlled study[J].Intensive Care Med,2014,40(6):830-838.
[42]Gotts JE,Matthay MA.Sepsis:Pathophysiology and clinical management[J].BMJ,2016,53:i1585.
[43]Zhang Z.Recombinant human activated protein C for the treatment of severe sepsis and septic shock:A study protocol for incorporating observational evidence using a Bayesian approach[J].BMJ Open,2014,4(7):e005622.
[44]Levy MM,Rhodes A,Phillips GS,et al.Surviving Sepsis Campaign:Association between performance metrics and outcomes in a7.5-year study[J].Crit Care Med,2015,43(1):3-12.
[45]Marik PE,Khangoora V,Rivera R,et al.Hydrocortisone,Vitamin C,and Thiamine for the Treatment of Severe Sepsis and Septic Shock:A Retrospective Before-After Study[J].Chest,2017,151(6):1229-1238.
[46]Marik PE.Vitamin C for the treatment of sepsis:The scientific rationale[J].Pharmacol Ther,2018,189:63-70.
[47]Steeland S,Libert C,Vandenbroucke RE.A New Venue of TNFTargeting[J].Int J Mol Sci,2018,19(5).pii:E1442.
[48]Poli EC,RimmeléT,Schneider AG.Hemoadsorption with CytoSorb~? [J].Intensive Care Med,2019,45(2):236-239.
[49]Poli EC,Simoni C,Andre P,et al.Clindamycin clearance during Cytosorb~? hemoadsorption:A case report and pharmacokinetic study[J].Int J Artif Organs,2019 42(4):190-193.