重症感染的临床诊治进展 王宇明 （第三军医大学西南医院全军感染病 .docVIP

重症感染的临床诊治进展 王宇明 （第三军医大学西南医院全军感染病研究所 重庆 400038） 【摘要】迄今为止重症感染聚合酶链反应（PCR）检测更快速检测自发性细菌性腹膜炎（SBP）加强院内感染控制规范抗生素使用是减少耐药细菌出现的主要手段血红蛋白结合蛋白）的清道夫蛋白Slit蛋白清道夫蛋白Slit蛋白Progress of clinical diagnosis and treatment in severe infections WANG Yu-ming 【Abstract】Severe infections have been the main cause of death in clinical patients and their diagnosis and treatment have been difficult so far. In clinical diagnosis, polymerase chain reaction (PCR) testing can be more quickly and accurately detect pathogens. However, further clinical practice remains to be explored. One of the most common seen severe infections, spontaneous bacterial peritonitis (SBP), has a high clinical misdiagnosis rate and poor prognosis, so the diagnosis conditions should be lowered down and intensive treatment should be emphasized. More aspects in the treatment have been studied, including the relationship of glucocorticoid dosage, duration of treatment and severity of disease. As for the control of increasing bacteria resistance, enhancing the control of nosocomial infections and regulating the use of antibiotics are the primary means. Recently, new treatments have been developed, including hemoglobin-binding protein (Hb), scavenger protein and Slit protein which are potential drugs for the treatment of severe infections in the future. Finally, many potential areas of research have been proposed 【Keywords】Severe infection, Diagnosis, Treatment, glucocorticoid, Scavenger protein, Slit protein, Progress 长期以来，重症感染一直是导致患者死亡的主要疾病近年，抗感染治疗和器官功能支持技术取得了长足的进步，但重症感染的病死率仍高达30%～70%[1]为了降低危重感染患者的率，多学者致力于这方面的研究工作，近年来重症感染的研究进展做一。脓毒症诊断脓毒症的诊断多依赖于传统的培养方法，一般需要2检测出感染原形态、具体种属、药物敏感性等结果[]。适当的抗微生物治疗减少脓毒症患者的率更快速的检测方法。Tissari等[]研究发现，通过基于DNA的微阵列）方法的分子检测技术确定感染原的菌属，敏感性、特异性均较高，且所需时间比传统培养更少。该检测将更早、更快干预脓毒症。Bloos等[]研究显示聚合酶链反应（PCR）血培养（BC）降钙素原（PCT）PCR法有轻度关联（呈平行关系），而PCR法敏感性明显高于BC法，尤以白细胞介素6（IL-6）血培养结果阴性，以PCR为基础的病原体检测结果与疾病严重程度相关，提示血液中存在微生物DNA具有重要意义。考虑到PCR法敏感性极高，今后应开展PCR DNA定量方法更为准确。分子技术的检测可针对临床常见的种属，提供准确、快速的检测结果不