《中医药单用/联合抗生素治疗常见感染性疾病临床实践指南·脓毒症》解读与展望
|
摘要
《中医药单用/联合抗生素治疗脓毒症临床实践指南》严格按照最新的脓毒症诊断标准(sepsis 3)对不同阶段的脓毒症患者进行辨证论治。目前,抗生素的滥用及耐药菌的流行十分严峻,目前尚无很好的解决方法,鉴于这一时代背景,该《指南》首次将关注点聚焦于中医药联合抗生素治疗脓毒症以尽可能减少耐药菌的发生率。从内容而言,《指南》系统分析了脓毒症期、脓毒症休克期以及脓毒症过程中出现脏器功能障碍时的不同临床表现及中医应对措施。通过对该《指南》的系统解读与分析,使得临床一线医生了解制定的目的与意义,理解《指南》的核心理念,掌握所推荐的具体干预措施和利弊关系,以期更好地将《指南》落地,指导临床医生使用,规范脓毒症的中医药治疗。
Clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for sepsis is strictly in accordance with the latest diagnostic criteria for sepsis( sepsis-3) for the treatment of septic patients at different stages through syndrome differentiation. At present,the abuse of antibiotics and the prevalence of drug-resistant bacteria are very serious,without effective solutions. Thus,this is the first time to focus on traditional Chinese medicine combined with antibiotics to treat sepsis,in order to minimize the incidence of drug-resistant bacteria. This Guideline tends to systematically analyze the sepsis period,septic shock period as well as different clinical symptoms and traditional Chinese medicine measures for organ dysfunction in the sepsis process. By analyzing and interpreting the Guideline systematically,the clinicians could understand its purpose,significance and core ideas more thoroughly,and grasp the recommended specific interventions as well as their advantages and disadvantages,hoping to better implement the Guideline,provide guidance to clinicians and standardize the treatment of sepsis by traditional Chinese medicine.
Clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for sepsis is strictly in accordance with the latest diagnostic criteria for sepsis( sepsis-3) for the treatment of septic patients at different stages through syndrome differentiation. At present,the abuse of antibiotics and the prevalence of drug-resistant bacteria are very serious,without effective solutions. Thus,this is the first time to focus on traditional Chinese medicine combined with antibiotics to treat sepsis,in order to minimize the incidence of drug-resistant bacteria. This Guideline tends to systematically analyze the sepsis period,septic shock period as well as different clinical symptoms and traditional Chinese medicine measures for organ dysfunction in the sepsis process. By analyzing and interpreting the Guideline systematically,the clinicians could understand its purpose,significance and core ideas more thoroughly,and grasp the recommended specific interventions as well as their advantages and disadvantages,hoping to better implement the Guideline,provide guidance to clinicians and standardize the treatment of sepsis by traditional Chinese medicine.
引文
[1] Singer M,Deutschman C S,Seymour C W,et al. The third international consensus definitions for sepsis and septic shock(sepsis 3)[J]. J Am Med Assoc,2016,315(8):801.
[2] Dellinger R P,Carlet J M,Masur H,et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock[J]. Crit Care Med,2004,32(3):858.
[3] Dellinger R P,Levy M M,Carlet J M,et al. Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock:2008[J]. Intensive Care Med,2008,34(1):17.
[4] Dellinger R P,Levy M M,Rhodes A,et al. Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock:2012[J]. Crit Care Med,2013,41(2):580.
[5] Rhodes A,Evans L E,Alhazzani W,et al. Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016[J]. Intensive Care Med,2017,43(3):304.
[6]谢剑锋,邱海波.拯救脓毒症运动:脓毒症与感染性休克治疗国际指南(2016)的进展与评论[J].中华重症医学电子杂志,2017,3(1):18.
[7]刘毅,宋诗铎,王洪霞. ICU医院感染相关脓毒症病原菌分布及耐药性分析[J].中华医院感染学杂志,2010,20(3):421.
[8]胡付品,朱德妹,汪复,等. 2013年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2014,14(5):365.
[9]孔令博,郭玉红,付跃峰,等.芪归银方对多重耐药铜绿假单胞菌感染大鼠血清IL-1β水平的影响[J].世界中医药,2016,11(10):1966.
[10] Kong L B,Ma Q,Gao J,et al. Effect of Qiguiyin Decoction on multidrug-resistant pseudomonas aeruginosa infection in rats[J].Chin J Integr Med,2015,21(12):916.
[11]孔令博,刘清泉,杨琦,等.芪归银方对抗生素体外抑制多重耐药铜绿假单胞菌作用的影响[J].世界中医药,2014,9(3):288.
[12]孔令博,刘清泉,王兰,等.芪归银方对多重耐药铜绿假单胞菌感染大鼠淋巴细胞增殖的影响[J].中医杂志,2013,54(18):1585.
[13]高洁,刘清泉,田金洲,等.芪归银方对耐亚胺培南铜绿假单胞菌耐药作用的影响[J].中医杂志,2012,53(16):1408.
[14]陈美玲,王剑,周红霞,等.中药饮片对多重抗生素耐药细菌的抑菌作用[J].中医药学报,2012,42(2):10.
[15]黄伟.《第三版脓毒症与感染性休克定义国际共识》解读[J].中国实用内科杂志,2016,36(11):959.
[16]刘清泉.脓毒症中西医结合诊治专家共识[C].广州:全国中西医结合危重病、急救医学学术会议,2008.
[17]王银芳,陈愉生.脓毒症患者免疫失衡与疾病严重程度关系的临床研究[J].福建医药杂志,2015,37(6):104.
[18]邱泽亮,叶一萍,张宁,等.参附注射液对严重脓毒症免疫调节的前瞻性研究[J].中华中医药学刊,2012,30(2):363.
[19] Lin C W,Lo S,Hsu C,et al. T-cell autophagy deficiency increases mortality and suppresses immune responses after sepsis[J]. PLo S ONE,2014,9(7):e102066.
[20]马晓春.脓毒症指南带给我们的几点思考[J].中华危重病急救医学,2015,27(6):427.
[21]张瑞,赵国桢,陈奕杉,等.《中医药单用/联合抗生素治疗常见感染性疾病临床实践指南·脓毒症》临床应用评价与修订意见[J].中国中药杂志,2018,43(24):4776.
[2] Dellinger R P,Carlet J M,Masur H,et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock[J]. Crit Care Med,2004,32(3):858.
[3] Dellinger R P,Levy M M,Carlet J M,et al. Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock:2008[J]. Intensive Care Med,2008,34(1):17.
[4] Dellinger R P,Levy M M,Rhodes A,et al. Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock:2012[J]. Crit Care Med,2013,41(2):580.
[5] Rhodes A,Evans L E,Alhazzani W,et al. Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016[J]. Intensive Care Med,2017,43(3):304.
[6]谢剑锋,邱海波.拯救脓毒症运动:脓毒症与感染性休克治疗国际指南(2016)的进展与评论[J].中华重症医学电子杂志,2017,3(1):18.
[7]刘毅,宋诗铎,王洪霞. ICU医院感染相关脓毒症病原菌分布及耐药性分析[J].中华医院感染学杂志,2010,20(3):421.
[8]胡付品,朱德妹,汪复,等. 2013年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2014,14(5):365.
[9]孔令博,郭玉红,付跃峰,等.芪归银方对多重耐药铜绿假单胞菌感染大鼠血清IL-1β水平的影响[J].世界中医药,2016,11(10):1966.
[10] Kong L B,Ma Q,Gao J,et al. Effect of Qiguiyin Decoction on multidrug-resistant pseudomonas aeruginosa infection in rats[J].Chin J Integr Med,2015,21(12):916.
[11]孔令博,刘清泉,杨琦,等.芪归银方对抗生素体外抑制多重耐药铜绿假单胞菌作用的影响[J].世界中医药,2014,9(3):288.
[12]孔令博,刘清泉,王兰,等.芪归银方对多重耐药铜绿假单胞菌感染大鼠淋巴细胞增殖的影响[J].中医杂志,2013,54(18):1585.
[13]高洁,刘清泉,田金洲,等.芪归银方对耐亚胺培南铜绿假单胞菌耐药作用的影响[J].中医杂志,2012,53(16):1408.
[14]陈美玲,王剑,周红霞,等.中药饮片对多重抗生素耐药细菌的抑菌作用[J].中医药学报,2012,42(2):10.
[15]黄伟.《第三版脓毒症与感染性休克定义国际共识》解读[J].中国实用内科杂志,2016,36(11):959.
[16]刘清泉.脓毒症中西医结合诊治专家共识[C].广州:全国中西医结合危重病、急救医学学术会议,2008.
[17]王银芳,陈愉生.脓毒症患者免疫失衡与疾病严重程度关系的临床研究[J].福建医药杂志,2015,37(6):104.
[18]邱泽亮,叶一萍,张宁,等.参附注射液对严重脓毒症免疫调节的前瞻性研究[J].中华中医药学刊,2012,30(2):363.
[19] Lin C W,Lo S,Hsu C,et al. T-cell autophagy deficiency increases mortality and suppresses immune responses after sepsis[J]. PLo S ONE,2014,9(7):e102066.
[20]马晓春.脓毒症指南带给我们的几点思考[J].中华危重病急救医学,2015,27(6):427.
[21]张瑞,赵国桢,陈奕杉,等.《中医药单用/联合抗生素治疗常见感染性疾病临床实践指南·脓毒症》临床应用评价与修订意见[J].中国中药杂志,2018,43(24):4776.