我们现在已经更有了世界糖尿病日、乳腺癌关爱日、世界哮喘日、世界艾滋病日、甚至少见病日，能不能有一个日子是为 Sepsis 而设？2012年9月13日是第一个World Sepsis Day ，旨在提高人们对脓毒血症的认识和重视，到今天2016年9月13日是第六个World Sepsis Day， Sepsis查阅英文字典有翻译为脓毒症和败血症，所以中文的译名可以翻译为世界脓毒症日或者世界败血症日，感觉媒体以第一翻译为主，个人建议直接用英文。
What is sepsis?
Sepsis is a life-threatening condition that occurs when the body's response to an infection damages its own tissues and organs. Instead of local inflammation resulting from a local infection, which would be the appropriate response, the body’s entire system goes into inflammation. That’s sepsis. It is the leading cause of death from infection around the world, despite advances in modern medicine like vaccines, antibiotics, and acute care. Millions of people around the world die of sepsis every year.
什么是脓毒血症？
脓毒血症是机体对感染作出反应后导致的对自身的组织和器官损坏的威胁生命的一种状态。局部感染导致局部的炎症反应，但是脓毒血症会导致全身的炎症反应。尽管现在有了疫苗、抗生素等更先进的治疗方法，但脓毒血症仍是感染引起死亡的重要原因之一。全世界每年都有上百万的人死于脓毒血症。
How can this “inflammation” result in death?
This inflammatory response can lead to dehydration and changes in circulation, for instance a drop in blood pressure. This can compromise the ability of the circulatory system to provide adequately oxygen etc. to the tissues. That leads to dysfunction in various organs, such as the lung, heart, kidney, and brain. It can also lead to shock, multiple organ failure, and death, especially if it is not recognized early and treated promptly. Sepsis is an emergency.
炎症是怎么导致死亡的？
脓毒血症这种全身的炎症反应可以导致脱水和体内循环的改变，例如血压的下降。导致循环系统摄氧的能力损伤，然后引起不同的器官功能失调，例如心脏、肺、肾脏、脑等。如果在早期没有及时的发现和正确的治疗，同样也可以引起休克、多器官衰竭甚至死亡，因此脓毒血症就是紧急情况。
How do I know it is sepsis?
Usually the first symptoms are those associated with the source of infection, such as a cough due to pneumonia or abdominal pain from appendicitis. Fever, a high pulse rate, and accelerated breathing are also signs. Everyone should be aware of the main clinical symptoms that indicate the worsening of an infection. Shortness of breath, reduction in urine output, dizziness, or altered mental status with confusion, agitation, or drowsiness can be signs of organ dysfunctions. In laboratory tests, sepsis often coincides with high white blood cell counts. But in the highly acute phase, and especially in immunocompromised patients, there may also be a decrease in white blood cell counts. In most cases, indicators of inflammation are increased.
怎么知道是脓毒血症？
脓毒血症最常早的症状总是与感染相关，比如肺炎引起的咳嗽或者是阑尾炎导致的腹痛。也会引起发热、脉搏加快、呼吸急促等。每个人都应该知道感染加剧导致的主要临床表现。呼吸短促、尿量减少、头晕、精神状态的改变、易怒、抑郁都是器官功能失调的表现。实验室检查中，脓毒血症总是伴有白细胞的升高。但是在急性期，特别是免疫损伤的患者，有时会表现为白细胞减少。大多数情况下，炎症指标都是升高的。
Can sepsis be treated successfully?
Yes. The first hours of treatment are the most important. Patients must receive appropriate antibiotic therapy as soon as possible. Blood cultures and cultures from the site of infection under suspicion should be taken to detect the cause. Patients should also have their blood lactate levels measured, as this is a sign of dysfunction in the circulatory system. Patients with severe signs, such as hypotension and elevated lactate levels, should also receive fluids. Depending on the severity of organ dysfunction, they may require treatment in an intensive care unit.
If the sepsis has been caused by an infected foreign object in the body, a stone in the renal pelvis, or a ruptured intestine, then antibiotics alone are not enough. In these cases the focus of the sepsis or the foreign object needs to be removed surgically.
脓毒血症能被治好吗？
是的。尽早治疗是最重要的。患者必须尽早接受合理的抗生素治疗。为找到病因，应该做血培养和疑似感染部位的培养。应该监测患者的乳酸LDH水平，因为这个指标可以预示循环系统的失调。有严重表象的患者，如低血压、LDH升高，需要及时的补液。取决于器官失调的程度，严重的需要进行重症监护。
如果感染时机体外的因素导致的，比如肾盂的结石、肠道的破损，这种情况下单独的使用抗生素是不够的。这些情况下应该关注脓毒血症或者是外科治疗清除异物。
What can be done when sepsis no longer responds to any type of antibiotic?
Unfortunately there are more and more germs that are resistant even to antibiotics of last resort. The only choice left is then intensive care: measures to support the organ functions in the hope that the body's own immune system will be able to prevent the pathogens from spreading any further. But many of these patients cannot be helped.
如果脓毒血症对所有的抗生素都没有反应医生还可以做什么？
非常不幸的是有越来越多的微生物对几乎所有的抗生素都耐药。剩下的选择只有重症监护：器官功能的支持以期望集体自己的免疫系统能够租住病原菌的扩散。但是很多这样的病人也可能是无效的。
目前可以辅助诊断浓度血症的指标有经典的血常规相关指标，例如白细胞、中性粒细胞及百分比、中性粒细胞淋巴细胞比，以后又陆续发现了新的炎症或者脓毒血症的标志物，比如CRP，PCT等。每个指标都有自己的优点和缺点。目前最近几年国内应用较多的是PCT，降钙素原作为诊断脓毒血症有着很好的敏感性和特异性，但是也有一些情况并不适用。只有深入了解每个指标检测的原理，才能更好的服务于临床。另外这些炎症指标升高并不是诊断的终点而是起点，必须针对性的做血培养才能做到致病菌，微生物室才能针对性的做药敏试验，医生才能针对性的选择用药，最终帮助患者度过难关。
检验科可以做的就是多提供好的检测项目给临床，比如血常规、C反应蛋白、降钙素原、血培养等。只有规范的血培养送检才能提高找到病原菌的几率。目前国内的专家共识或者指南以及国际的指南一般都推荐双侧双套做血培养，也就是说血培养的单位是两套，而不是单瓶或者是单套。
BACTEC Lytic/10Anaerobic/F Culture Vials 含有溶血素的厌氧瓶（8-10ml/瓶）
BACTEC Peds plus/F Culture Vials 儿童瓶1-3ml/瓶
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