脓毒症最新指南（SCC2021版）

脓毒症最新指南（SCC2021版）脓毒症指南更新，抢先看一下脓毒症筛查和早期诊治•For hospitals and health systems, we recommend using a performance improvement programme for sepsis, including sepsis screening for acutely ill, high-risk patients and standard operating procedures for treatment.•对于医疗机构，推荐制定流程，以便能够快速识别、标准化救治脓毒症患者。

•We recommend against using qSOFA compared to SIRS, NEWS, or MEWS as a single screening tool for sepsis or septic shock.•不推荐单独使用qSOFA评分来筛查脓毒症、脓毒症休克。

•For adults suspected of having sepsis, we suggest measuring blood lactate.•怀疑脓毒症，推荐监测血乳酸。

•Sepsis and septic shock are medical emergencies, and we recommend that treatment and resuscitation begin immediately.•脓毒症和脓毒症休克情况紧急，需要立即救治。

•For patients with sepsis induced hypoperfusion or septic shock we suggest that at least 30 mL/kg of intravenous (IV) crystalloid fuid should be given within the frst 3 h of resuscitation.•伴有低血压、脓毒症休克的脓毒症患者，推荐3小时内给予至少30ml/kg的晶体液。

•For adults with sepsis or septic shock, we suggest using dynamic measures to guide fuid resuscitation, over physical examination or static parameters alone.•对于脓毒症和脓毒症休克的患者，推荐动态监测患者相关指标来评估液体复苏情况，不能单独依赖一个静态指标或体格检查。

•For adults with sepsis or septic shock, we suggest guiding resuscitation to decrease serum lactate in patients with elevated lactate level,over not using serum lactate.•对于脓毒症或脓毒症休克患者来说，如果乳酸升高，推荐动态监测乳酸，进行休克复苏来降低乳酸水平，而不是只看血清乳酸水平。

•For adults with septic shock, we suggest using capillary refll time to guide resuscitation as an adjunct to other measures of perfusion.•推荐使用毛细血管充盈时间作为复苏指标。

•For adults with septic shock on vasopressors, we recommend an initial target mean arterial pressure (MAP) of 65 mm Hg over higher MAP targets.•对于脓毒症休克患者来说，推荐初始MAP目标为≥65mmHg。

•For adults with sepsis or septic shock who require ICU admission, we suggest admitting the patients to the ICU within 6 h.•推荐脓毒症或脓毒症休克患者，如需ICU救治，在6小时内转入ICU。

诊治感染•For adults with suspected sepsis or septic shock but unconfrmed infection, we recommend continuously re-evaluating and searching for alternative diagnoses and discontinuing empiric antimicrobials if an alternative cause of illness is demonstrated or strongly suspected.•怀疑脓毒症或脓毒症休克，但没有明确感染，推荐持续评估、寻找其他诊断，如果不存在感染，撤除需广谱抗生素。

抗生素时间•For adults with possible septic shock or a high likelihood for sepsis, we recommend administering antimicrobials mmediately, ideally within 1 h of recognition.•如果患者是感染引起的脓毒症或脓毒症休克（或高度怀疑），需要尽快给予抗生素，理想状态下，应当1小时内使用抗生素。

•For adults with possible sepsis without shock, we recommend rapid assessment of the likelihood of infectious versus non-infectious causes of acute illness.•怀疑脓毒症但没有休克的患者，推荐评估感染、非感染疾病。

•For adults with possible sepsis without shock, we suggest a time-limited course of rapid investigation and if concern for infection persists, the administration of antimicrobials within 3 h from the time when sepsis was first recognised.•怀疑脓毒症但没有休克的患者，应当快速展开诊治。

如果考虑存在持续的感染，应当在考虑脓毒症诊治之后的3小时内给予抗生素。

•For adults with a low likelihood of infection and without shock, we suggest deferring antimicrobials while continuing to closely monitor the patient.•如果患者脓毒症概率很小且没有感染，建议无需使用抗生素，同时严密监测患者状态。

抗生素使用生物标志物•For adults with suspected sepsis or septic shock, we suggest against using procalcitonin plus clinical evaluation to decide when to start antimicrobials, as compared to clinical evaluation alone.•对于怀疑脓毒症、脓毒症休克的患者，不要依据降钙素原和临床评估来决定启用抗生素，也不能单独依赖临床评估。

抗生素选择•For adults with sepsis or septic shock at high risk of methicillin resistant staph aureus (MRSA), we recommend using empiric antimicrobials with MRSA coverage over using antimicrobials without MRSA coverage.•对于MRSA高危的脓毒症、脓毒症休克患者，推荐初始抗生素覆盖MRSA。

•For adults with sepsis or septic shock at low risk of methicillin resistant staph aureus (MRSA), we suggest against using empiric antimicrobials with MRSA coverage, as compared with using antimicrobials without MRSA coverage.•对于无MRSA高危的脓毒症、脓毒症休克患者，不推荐初始抗生素覆盖MRSA。

•For adults with sepsis or septic shock and high risk for multidrug resistant (MDR) organisms, we suggest using two antimicrobials with gram-negative coverage for empiric treatment over one gram-negative agent.•对于MDR高危患者，推荐使用两种可覆盖G-菌的抗生素，而不是单独用药。

•For adults with sepsis or septic shock and low risk for MDR organisms,we suggest against using two Gram-negative agentsfor empiric treatment, as compared to one Gram-negative agen.•对于无MDR高危的患者，不推荐联合用药。

•For adults with sepsis or septic shock, we suggest against using double gram-negative coverage once the causative pathogen and the susceptibilities are known.•当病原菌明确、药敏明确，不推荐联合用药。