敗血症の定義の改訂 in 2016年 オーランドSCCM SEPSIS-3

敗血症の定義の改訂 in 2016年 
オーランドSCCM、SEPSIS-3



ついに敗血症の定義が改訂されました。そろそろではないかと噂されていましたが、数日前にお披露目となりました。雑誌はJAMAです。2016年2月23日に出た、出来立てホヤホヤの新定義です。

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, Bellomo R, Bernard GR, Chiche JD, Coopersmith CM, Hotchkiss RS, Levy MM, Marshall JC, Martin GS, Opal SM, Rubenfeld GD, van der Poll T, Vincent JL, Angus DC.The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10. doi: 10.1001/jama.2016.0287.
以下URL

Sepsis and Septic Shockの頭文字と今回の改訂数からでしょうか「SEPSIS-3」という名前のコンセンサスとしています。このようなちょっとしたインパクトのある名前にした発想は、個人的にとても好きです。

ちなみに重症敗血症という言葉は無くなりました。(以前は敗血症、重症敗血症、敗血症性ショックの3つでした)今後は敗血症が従来の重症敗血症と同じ意味になります。元々臨床の現場では敗血症というと、ほとんど重症のものを指していたので、より現場にあったものになったのではないかと思います。

1. 敗血症の定義
新定義:「感染症に対して制御不可能な宿主反応を起こし、生命を脅かす臓器障害を伴う」

2. 敗血症の診断基準
新基準:ICU患者とそれ以外(院外,ER,一般病棟)で区別
 ICU患者:感染症が疑われSOFAスコアが2点以上増加
 一般患者:qSOFAスコアで2点以上

このqSOFA(クイックSOFA)ですが、今回初めて登場しました。元々のSOFAスコアはとても有名なスコアでICUで現在もよく用いられますが、なかなか点数化がややこしく表を見ないと点数化で来ませんでした。現場が使用しやすいスコアを作るということはとても良いことではないかと思います。

以下がqSOFAスコアです。わかりやすいですね。
e0345436_13071741.jpg


今後の敗血症の実際の治療の流れは以下になります。(少し文字が見にくいですが)

e0345436_13083655.jpg

今後私たちの研究にも影響を及ぼしそうです。
私も今後敗血症に関して皆が注目するような研究を出来ればと思っています。








by kaigaiwataihenda | 2016-02-26 13:20 | 敗血症 | Comments(41)
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