2023版国际烧伤学会《拯救烧伤脓毒症运动指南》解读

朱伟; 彭毅志; 罗高兴; 袁志强

doi:10.3760/cma.j.cn501225-20250403-00164

2023版国际烧伤学会《拯救烧伤脓毒症运动指南》解读

doi: 10.3760/cma.j.cn501225-20250403-00164

陆军军医大学（第三军医大学）第一附属医院全军烧伤研究所,创伤与化学中毒全国重点实验室,重庆市创面修复与组织再生重点实验室,重庆　　400038

基金项目:

国家自然科学基金面上项目 82372515, 82072171

详细信息

通讯作者:
袁志强,Email：yuanzq@tmmu.edu.cn

计量
- 文章访问数: 195
- HTML全文浏览量: 32
- PDF下载量: 27
- 被引次数: 0
出版历程
- 收稿日期: 2025-04-03

Interpretation of the 2023 International Society for Burn Injuries "Surviving Sepsis After Burn Campaign"

Institute of Burn Research, State Key Laboratory of Trauma and Chemical Poisoning, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing Key Laboratory for Wound Repair and Tissue Regeneration, Chongqing 400038, China

Funds:

General Program of National Natural Science Foundation of China 82372515, 82072171

More Information

Corresponding author: Yuan Zhiqiang, Email: yuanzq@tmmu.edu.cn

摘要

摘要: 国际烧伤学会于2023年发布的《拯救烧伤脓毒症运动指南》,是首部针对烧伤患者进行脓毒症管理的国际指南。该指南首次系统整合烧伤脓毒症的诊断、预防与治疗策略,内容涵盖从早期预警指标（如脓毒症相关性器官功能衰竭评价评分变化、降钙素原趋势）到个体化干预（如创面处理、抗生素降阶梯治疗）的全流程管理。尤为重要的是,该指南强调“以器官功能为导向”的动态评估框架,突破传统生物标志物的局限,并针对烧伤脓毒症特有的高代谢状态、创面感染及多重耐药菌感染风险等提出了创新性建议。该文结合国际烧伤脓毒症研究进展,对该指南要点进行深度解析,为临床实践提供循证依据。
- 烧伤 /
- 脓毒症 /
- 器官功能障碍 /
- 指南解读
Abstract: The Surviving Sepsis After Burn Campaign published by the International Society for Burn Injuries in 2023, are the first international guidelines for the management of sepsis in burn patients. The guidelines systematically integrate the strategies for the diagnosis, prevention, and treatment of burn sepsis for the first time, encompassing the whole processes of sepsis management from early warning indicators (such as dynamic changes in sepsis-related organ failure assessment scores and procalcitonin trends) to personalized interventions (such as wound management and antibiotic de-escalation therapy). More importantly, the guidelines emphasize an organ function-oriented dynamic assessment framework, breaking through the limitations of traditional biomarkers and put forward innovative recommendations specifically for the hypermetabolic state, wound infections, and risks of multidrug-resistant organisms infections uniquely associated with burn sepsis. Based on the progress of international research on burn sepsis, this article provides an in-depth analysis of the guidelines' key points, offering evidence-based insights for clinical practice.
- Burns /
- Sepsis /
- Organ dysfunction /
- Guideline interpretation
所有作者声明不存在利益冲突

HTML全文

参考文献(40)

[1]	Meza-EscobarLE, RehouS, JeschkeMG. Sepsis definitions in burns[J]. Surg Infect (Larchmt), 2021,22(1):28-36. DOI: 10.1089/sur.2020.297.
[2]	BoehmD, MenkeH. Sepsis in burns-lessons learnt from developments in the management of septic shock[J]. Medicina (Kaunas), 2021,58(1):26.DOI: 10.3390/medicina58010026.
[3]	BoneRC, BalkRA, CerraFB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine[J]. Chest, 1992,101(6):1644-1655. DOI: 10.1378/chest.101.6.1644.
[4]	LevyMM, FinkMP, MarshallJC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference[J]. Crit Care Med, 2003,31(4):1250-1256. DOI: 10.1097/01.CCM.0000050454.01978.3B.
[5]	SingerM, DeutschmanCS, SeymourCW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)[J]. JAMA, 2016,315(8):801-810. DOI: 10.1001/jama.2016.0287.
[6]	GreenhalghDG. Sepsis in the burn patient: a different problem than sepsis in the general population[J/OL]. Burns Trauma, 2017,5:23[2025-04-03]. https://pubmed.ncbi.nlm.nih.gov/28795054/. DOI: 10.1186/s41038-017-0089-5.
[7]	PorterC, TompkinsRG, FinnertyCC, et al. The metabolic stress response to burn trauma: current understanding and therapies[J]. Lancet, 2016,388(10052):1417-1426. DOI: 10.1016/S0140-6736(16)31469-6.
[8]	DellingerRP, CarletJM, MasurH, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock[J]. Crit Care Med, 2004,32(3):858-873. DOI: 10.1097/01.ccm.0000117317.18092.e4.
[9]	DellingerRP, LevyMM, CarletJM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008[J]. Crit Care Med, 2008,36(1):296-327. DOI: 10.1097/01.CCM.0000298158.12101.41.
[10]	DellingerRP, LevyMM, RhodesA, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012[J]. Intensive Care Med, 2013,39(2):165-228. DOI: 10.1007/s00134-012-2769-8.
[11]	RhodesA, EvansLE, AlhazzaniW, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock: 2016[J]. Intensive Care Med, 2017,43(3):304-377. DOI: 10.1007/s00134-017-4683-6.
[12]	EvansL, RhodesA, AlhazzaniW, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021[J]. Intensive Care Med, 2021,47(11):1181-1247. DOI: 10.1007/s00134-021-06506-y.
[13]	姚咏明,柴家科,盛志勇. 烧伤脓毒症的诊断标准与防治[J]. 中华烧伤杂志,2003,19(2):65-66.
[14]	GreenhalghDG, SaffleJR, 4thHolmes JH, et al. American Burn Association consensus conference to define sepsis and infection in burns[J]. J Burn Care Res, 2007,28(6):776-790. DOI: 10.1097/BCR.0b013e3181599bc9.
[15]	中国医师协会烧伤医师分会, 《烧伤感染诊治指南》编辑委员会. 烧伤感染的诊断标准与治疗指南(2012版)[J].中华烧伤杂志,2012,28(6):401-403. DOI: 10.3760/cma.j.issn.1009-2587.2012.06.001.
[16]	GreenhalghDG, HillDM, BurmeisterDM, et al. Surviving Sepsis After Burn Campaign[J]. Burns, 2023,49(7):1487-1524. DOI: 10.1016/j.burns.2023.05.003.
[17]	VincentJL, MorenoR, TakalaJ, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine[J]. Intensive Care Med, 1996,22(7):707-710. DOI: 10.1007/BF01709751.
[18]	DokterJ, BrusselaersN, HendriksWD, et al. Bacteriological cultures on admission of the burn patient: to do or not to do, that's the question[J]. Burns, 2016,42(2):421-427. DOI: 10.1016/j.burns.2015.08.006.
[19]	罗高兴,詹日兴,袁志强,等. 建议应用自来水冲洗代替生理盐水清洁皮肤创面[J]. 中华烧伤与创面修复杂志,2025,41(3):201-205.DOI: 10.3760/cma.j.cn501225-20250108-00015.
[20]	中国老年医学学会烧创伤分会, 中华医学会烧伤外科学分会重症学组. 成人烧伤俯卧位治疗全国专家共识(2022版)[J]. 中华烧伤与创面修复杂志, 2022, 38(7):601-609. DOI: 10.3760/cma.j.cn501120-20211208-00407.
[21]	中华医学会烧伤外科学分会. 严重烧伤患者深静脉置管操作和管理的全国专家共识(2020版)[J]. 中华烧伤杂志, 2021, 37(2): 101-112. DOI: 10.3760/cma.j.cn501120-20201122-00487.
[22]	罗高兴, 李海胜, 袁志强, 等. 建议在烧伤休克期不常规预防性全身使用抗菌药物[J].中华烧伤与创面修复杂志,2024,40(10):911-914. DOI: 10.3760/cma.j.cn501225-20240809-00300.
[23]	LiAT, MoussaA, GusE, et al. Biomarkers for the early diagnosis of sepsis in burns: systematic review and meta-analysis[J]. Ann Surg, 2022,275(4):654-662. DOI: 10.1097/SLA.0000000000005198.
[24]	《中华传染病杂志》编辑委员会. 中国宏基因组学第二代测序技术检测感染病原体的临床应用专家共识[J].中华传染病杂志,2020,38(11):681-689. DOI: 10.3760/cma.j.cn311365-20200731-00732.
[25]	LevyMM, EvansLE, RhodesA. The Surviving Sepsis Campaign Bundle: 2018 update[J]. Intensive Care Med, 2018,44(6):925-928. DOI: 10.1007/s00134-018-5085-0.
[26]	中国医疗保健国际交流促进会烧伤医学分会,《中华烧伤与创面修复杂志》编辑委员会. 烧伤侵袭性真菌感染诊断与防治实践指南(2024版)[J].中华烧伤与创面修复杂志,2024,40(7):604-617. DOI: 10.3760/cma.j.cn501225-20240103-00003.
[27]	BrunkhorstFM, HeinzU, ForyckiZF. Kinetics of procalcitonin in iatrogenic sepsis[J]. Intensive Care Med, 1998,24(8):888-889. DOI: 10.1007/s001340050683.
[28]	CabralL, AfreixoV, MeirelesR, et al. Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients - a retrospective observational study[J]. BMC Anesthesiol, 2018,18(1):122. DOI: 10.1186/s12871-018-0585-6.
[29]	中国老年医学学会烧创伤分会. 脉搏轮廓心排血量监测技术在严重烧伤治疗中应用的全国专家共识(2018版)[J]. 中华烧伤杂志, 2018, 34(11): 776-781. DOI: 10.3760/cma.j.issn.1009-2587.2018.11.011.
[30]	MartinGS, BassettP. Crystalloids vs. colloids for fluid resuscitation in the Intensive Care Unit: a systematic review and meta-analysis[J]. J Crit Care, 2019,50:144-154. DOI: 10.1016/j.jcrc.2018.11.031.
[31]	RussellJA, WalleyKR, SingerJ, et al. Vasopressin versus norepinephrine infusion in patients with septic shock[J]. N Engl J Med, 2008,358(9):877-887. DOI: 10.1056/NEJMoa067373.
[32]	吕行, 宋立强. 感染中毒性休克的液体复苏和血管活性药物应用的时机、评价标准与规范[J].中华结核和呼吸杂志,2024,47(10):917-920. DOI: 10.3760/cma.j.cn112147-20240703-00380.
[33]	PalmieriTL, 4thHolmes JH, ArnoldoB, et al. Transfusion requirement in burn care evaluation (TRIBE): a multicenter randomized prospective trial of blood transfusion in major burn injury[J]. Ann Surg, 2017,266(4):595-602. DOI: 10.1097/SLA.0000000000002408.
[34]	佐方清, 苏加庆, 李阳, 等. 大面积烧伤患者住院期间血红蛋白最低值与预后的关系[J]. 中华烧伤与创面修复杂志, 2024, 40(6): 543-550. DOI: 10.3760/cma.j.cn501225-20240228-00075.
[35]	AlhazzaniW, AlshahraniM, JaeschkeR, et al. Neuromuscular blocking agents in acute respiratory distress syndrome: a systematic review and meta-analysis of randomized controlled trials[J]. Critical Care (London, England), 2013, 17(2):R43. DOI: 10.1186/cc12557.
[36]	BlackwoodB, BurnsKE, CardwellCR, et al. Protocolized versus non-protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients[J]. Cochrane Database Syst Rev, 2014,2014(11):CD006904. DOI: 10.1002/14651858.CD006904.pub3.
[37]	MurphyCV, CoffeyR, CookCH, et al. Early glycemic control in critically ill patients with burn injury[J]. J Burn Care Res, 2011,32(6):583-590. DOI: 10.1097/BCR.0b013e31822dc3da.
[38]	StoecklinP, DelodderF, PantetO, et al. Moderate glycemic control safe in critically ill adult burn patients: a 15 year cohort study[J]. Burns, 2016,42(1):63-70. DOI: 10.1016/j.burns.2015.10.025.
[39]	YatabeT, InoueS, SakaguchiM, et al. The optimal target for acute glycemic control in critically ill patients: a network meta-analysis[J]. Intensive Care Med, 2017,43(1):16-28. DOI: 10.1007/s00134-016-4558-2.
[40]	DermanBA, SchleiZ, ParsadS, et al. Changes in intravenous immunoglobulin usage for hypogammaglobulinemia after implementation of a stewardship program[J]. JCO Oncol Pract, 2021,17(3):e445-e453. DOI: 10.1200/OP.20.00312.