中国地区三级甲等医院三种清洁手术预防用抗菌药物的干预研究研究报告
卫生部、WHO 2008－2009合作项目课题
WHO WP/2008/chn/04·07项目经费资助
报告人：郑迎东
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外科术后脓毒症以及感染性休克的相关研究评估
Study Examines Sepsis And Septic Shock After Surgery外科术后脓毒症以及感染性休克的相关研究评估http://news.dxy.cn/bbs/post/view?bid=116&id=17897530&tpg=1&age=0
Sepsis and septic shock appear to be more common than heart attacks or pulmonary blood clots among patients having general surgery, and the death rate for patients with septic shock is approximately 34 percent within 30 days of operation, according to a report in the July issue of Archives of Surgery, one of the JAMA/Archives journals.
根据一项发表在7月刊《外科文献》上研究报告（该期刊是美国医学协会期刊/文献期刊的一种）：患者行外科大手术后，脓毒症以及感染性休克的发生率似乎比心脏病和肺栓塞的发生率还要高，感染性休克在术后30天内的致死率高达34%。
"Prevention of perioperative complications is a major focus in the care of the general-surgery patient," the authors write as background information in the article. In recent years, attention has been focused on prevention of venous thromboembolism (including post-operative deep vein thrombosis, or blood clots in the deep veins of the pelvis or extremities, and pulmonary embolism, or blood clots that travel to the lungs), myocardial infarction (heart attack) and surgical site infections. These efforts have resulted in awareness and reduction of these complications.
这篇文章的作者在该论文中写道：“围手术期并发症的预防是外科患者术后护理的重点。不过近年来，人们的注意力主要集中在静脉血栓栓塞的预防方面（包括术后预防深静脉血栓形成、骨盆和四肢深静脉血栓、肺动脉栓塞的预防，以及随血液循环至肺部的栓子导致的肺栓塞的预防）、心肌梗死（心脏病发作）和手术部位感染等方面。这些努力在提高了人们的认识的同时也在一定程度上减少了术后患者并发症的发生。
Sepsis, an infection that usually results from bacteria in the bloodstream and can result in failure of multiple organ systems, is another potentially preventable cause of illness and death in general surgery patients, the authors note. Laura J. Moore, M.D., and colleagues at The Methodist Hospital, Weill Cornell Medical College, Houston, reviewed the incidence, mortality rate and risk factors for sepsis in general surgery patients using data from the 2005 to 2007 American College of Surgeons National Surgical Quality Improvement Program.
该论文作者劳拉博士指出，“脓毒症，是由血液中的细菌所致的一种感染，它可以导致多脏器功能衰竭，是普外科中另一种潜在的可导致患者不适和死亡的，但是可预防的病因”，劳拉博士和他休斯敦，威尔康乃尔医学院，Methodist 医院的同事通过分析2005年至2007年美国college of Surgeons National Surgical Quality Improvement Program的数据，回顾了脓毒症的发病率、死亡率以及普外科病人易感脓毒症的危险因素。
Of 363,897 general surgery patients, sepsis occurred in 8,350 (2.3 percent), septic shock or life-threatening low blood pressure due to sepsis occurred in 5,977 (1.6 percent), pulmonary embolism occurred in 1,078 (0.3 percent) and heart attack occurred in 615 (0.2 percent). Death rates within 30 days were 5.4 percent for sepsis, 33.7 percent for septic shock, 9.1 percent for pulmonary embolism and 32 percent for heart attack.
在363897例普外科病人中，发生败血症占8350例（2.3%），感染性休克或由脓毒症导致的恶性低血压者占5977例（1.6%），肺动脉栓塞者占1078例（0.3%），心脏病发作者占615例 （0.2%）。 30天之内的死亡率分别为败血症：5.4%，感染性休克：33.7%，肺栓塞：9.1%和心脏病发作：32%。
The results suggest that sepsis continues to be a common and serious complication in general surgery patients and occurs more frequently than pulmonary embolism or heart attack. "Of note, septic shock occurs 10 times more frequently than myocardial infarction and has the same mortality rate; thus, it kills 10 times more people," the authors write. "Therefore, our level of vigilance in identifying sepsis and septic shock needs to mimic, if not surpass, our vigilance for identifying myocardial infarction and pulmonary embolism."
“结果表明，脓毒症仍然是在普外科常见的严重并发症，其发生率比肺栓塞或心脏病发作还要高。 “值得注意的是，感染性休克的发生率是心肌梗死的10倍，而且他和心肌梗死有着相同的死亡率，因此，它杀会死10倍多的人”作者写道。 “因此，如果我们还没有对脓毒症和感染性休克足够重视的话，那么现在开始我们应该要像警惕心肌梗死，肺动脉栓塞一样警惕这两者了。”
Risk factors for sepsis and septic shock included age older than 60, the need for emergency surgery and the presence of any co-occurring illness. Having such an illness increased the risk of sepsis and septic shock six-fold and the risk of dying within 30 days 22-fold.
败血症和感染性休克的危险因素包括：年龄大于60岁、急诊手术、存在合并症的患者。这些因素使得脓毒症和感染性休克发生率提高了6倍， 30天内死亡率提高了22倍。
"By identifying three major risk factors for the development of and death from sepsis and septic shock in general-surgery patients, we can heighten our awareness for sepsis and septic shock in these at-risk populations," the authors conclude. "The implementation of mandatory sepsis screening for these high-risk populations has resulted in decreased sepsis-related mortality within our institution. Further evaluation of the role of sepsis screening programs in other settings is critical and could significantly reduce sepsis-related mortality in general-surgery patients."
作者总结道：这三个与脓毒症以及感染性休克的密切相关的因素的确认，使得我们可以提高对危险人群易患脓毒症及感染性休克的警惕性和认识”，他说：“在我们的机构中，对脓毒症高危人群的强制筛查的实施，已经降低了脓毒症相关的死亡率。而且在其他机构中，脓毒症筛查计划也被证明了是至关重要的，它可以显著降低普外科手术患者感染相关的死亡率。 先下载,以后认真学习了，感谢老师的认真辛勤劳动，再次谢谢。 {:1_12:}谢谢老师！下载学习了 已下载，非常感谢版主的分享！
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