摘要
脓毒症是机体对感染反应失调导致的危及生命的器官功能障碍。脓毒性休克是脓毒症死亡的主要原因,其核心病理生理机制是机体失调反应后血流与氧流紊乱导致的重症单元(由微循环与功能细胞线粒体组成)严重缺血缺氧。由于机体反应具有系统趋同但临床表现异质的特点,目前针对血流动力学的认知与管理策略尚未统一,易导致复苏不足或治疗过度。为提高救治质量,专家组在系统梳理“血流-氧流”理论基础上,强调从血流与氧流整合视角重新审视脓毒性休克,并制订了《脓毒性休克血流氧流分型与临床管理专家共识(2025)》。共识提出血流-氧流临床分型应综合心功能、血管张力、重症单元氧流利用状态和疾病时程,结合机体反应表型与人工智能技术优化亚型识别;倡导以器官灌注多部位氧流监测、外周灌注监测及重症超声构建连续评估体系;在“重症救治三角”框架下实施个体化、集束化管理策略,并针对多个管理位点提出了指导意见,以期恢复血流-氧流匹配,降低器官功能衰竭风险和患者病死率。
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.Septic shock is the primary cause of mortality in sepsis,with its core pathophysiological mechanism being severe ischemia and hypoxia in critical units——composed of microcirculation and the mitochondria of functional cells—resulting from disruptions in blood flow and oxygen flow following a dysregulated host response.Due to the systemically convergent yet clinically heterogeneous nature of the host response,current understanding and management strategies for hemodynamics remain inconsistent,often leading to inadequate resuscitation or overtreatment.To improve the quality of care,based on a systematic review of the"blood flow-oxygen flow"theory,an expert panel emphasizes reevaluating septic shock from an integrated perspective of blood flow and oxygen flow,and has formulated the Expert Consensus on Blood Flow and Oxygen Delivery Phenotyping and Clinical Management of Septic Shock(2025).The consensus proposes that clinical typing of blood flow-oxygen flow should comprehensively consider cardiac function,vascular tone,oxygen flow utilization status in critical units,and disease trajectory,while optimizing subtype identification by integrating host response phenotypes and artificial intelligence technologies.It advocates establishing a continuous assessment system through multi-site oxygen flow monitoring for organ perfusion,peripheral perfusion monitoring,and critical care ultrasound.Under the framework of the"critical care triangle",the consensus promotes the implementation of individualized,bundled management strategies,providing guidance for multiple management points to restore blood flow-oxygen flow matching,reduce the risk of organ failure,and decrease patient mortality.
作者
黄薇
王欣晨
柴文昭
崔克亮
姚波
邢志群
王翠
刘晶晶
巩师毅
李冬凯
尹万红
王小亭
杜微
HUANG Wei;WANG Xinchen;CHAI Wenzhao;CUI Keliang;YAO Bo;XING Zhiqun;WANG Cui;LIU Jingjing;GONG Shiyi;LI Dongkai;YIN Wanhong;WANG Xiaoting;DU Wei(Department of Critical Care Medicine,The First Affiliated Hospital of Xiamen University,Xiamen,Fujian 361003,China;Department of Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Critical Care Medicine,Tianjin Medical University Cancer Institute and Hospital,Tianjin 300060,China;Department of Critical Care Medicine,Qilu Hospital(Qingdao),Shandong University,Qingdao,Shandong 266000,China;Department of Critical Care Medicine,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Department of Critical Care Medicine,The First Affiliated Hospital of Anhui Medical University,Hefei 230000,China;Department of Critical Care Medicine,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《协和医学杂志》
北大核心
2026年第1期40-58,共19页
Medical Journal of Peking Union Medical College Hospital
基金
国家重点研发计划-常见多发病防治研究重点专项(2022YFC2504503)
中央高水平医院临床科研专项(2022-PUMCH-A-266)
国家科技重大专项(2024ZD0526100)。
