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中华重症医学电子杂志 doi: 10.3877/cma.j.issn.2096-1537.2026.01.09-001

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感染性休克早期关键治疗策略的EFSP框架
李建波, 李易, 尹万红, 康焰()   
  1. 610041 成都,四川大学华西医院重症医学科
  • 收稿日期:2025-12-30
  • 通信作者: 康焰
  • 基金资助:
    国家重点研发计划(2022YFC2504504); 国家自然科学基金青年科学基金项目(82302424)

The EFSP Framework for Principal Early Intervention Strategies in the Management of Septic Shock

Jianbo Li, Yi Li, Wanhong Yin, Yan Kang()   

  1. Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
  • Received:2025-12-30
  • Corresponding author: Yan Kang
引用本文:

李建波, 李易, 尹万红, 康焰. 感染性休克早期关键治疗策略的EFSP框架[J/OL]. 中华重症医学电子杂志, doi: 10.3877/cma.j.issn.2096-1537.2026.01.09-001.

Jianbo Li, Yi Li, Wanhong Yin, Yan Kang. The EFSP Framework for Principal Early Intervention Strategies in the Management of Septic Shock[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), doi: 10.3877/cma.j.issn.2096-1537.2026.01.09-001.

感染性休克是脓毒症最严重子集,病死率可达30%~50%。近年来,其治疗策略正从"一刀切"的集束化方案向"个体化"治疗模式转变。本文根据感染性休克诊疗的核心关键环节,提出感染性休克早期关键治疗策略的EFSP框架,即早期识别与转诊(E)、快速诊断与评估(F)、标准化治疗(S)及个体化治疗(P),旨在为临床医师提供最新诊治进展和实践指导。

Septic shock is the most severe subset of sepsis, with a mortality rate of 30%-50%. In recent years, its treatment strategy has been shifting from a "one-size-fits-all" bundled approach to a "personalized" treatment model. This review, based on the core key links in the diagnosis and treatment of septic shock, proposes the EFSP framework for early key treatment strategies for septic shock: Early recognition and referral (E), Fast diagnosis and assessment (F), Standardized treatment (S), and Personalized treatment (P). It aims to provide clinicians with the latest progress in diagnosis and treatment, as well as practical guidance.

图1 感染性休克早期关键治疗策略的EFSP框架 注:SSC为拯救脓毒症运动;MALS为巨噬细胞活化样综合征;SIIP为脓毒症诱导免疫麻痹;AI为人工智能
[1]
Meyer NJ, Prescott HC. Sepsis and septic shock [J]. N Engl J Med, 2024, 391(22): 2133-2146.
[2]
Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study [J]. Lancet, 2020, 395(10219): 200-211.
[3]
La Via L, Sangiorgio G, Stefani S, et al. The global burden of sepsis and septic shock [J]. Epidemiologia (Basel), 2024, 5(3): 456-478.
[4]
Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 [J]. Intensive Care Med, 2021, 47(11): 1181-1247.
[5]
Ngan C. Development and validation of a novel shock diagnosis and treatment protocol based on ultrasound visual information [D]. Chengdu: Sichuan University, 2024.
[6]
Thwaites L, Nasa P, Abbenbroek B, et al. Management of adult sepsis in resource-limited settings: global expert consensus statements using a Delphi method [J]. Intensive Care Med, 2025, 51(1): 21-38.
[7]
Durr D, Niemi T, Despraz J, et al. National early warning score (NEWS) outperforms quick sepsis-related organ failure (qSOFA) score for early detection of sepsis in the emergency department [J]. Antibiotics (Basel), 2022, 11(11): 1518.
[8]
Inada-Kim M. NEWS2 and improving outcomes from sepsis [J]. Clin Med (Lond), 2022, 22(6): 514-517.
[9]
Chua WL, Rusli KDB, Aitken LM. Early warning scores for sepsis identification and prediction of in-hospital mortality in adults with sepsis: a systematic review and meta-analysis [J]. J Clin Nurs, 2024, 33(6): 2005-2018.
[10]
Ranzani OT, Singer M, Salluh JIF, et al. Development and validation of the sequential organ failure assessment (SOFA)-2 Score [J]. JAMA, 2025.
[11]
Lamas C. Surviving sepsis campaign 2021: a summary of the new recommendations [J]. Heart, Vessels Transplant J, 2022, 6(1): 4-7.
[12]
Gotur DB. Sepsis diagnosis and management [J]. J Med Sci Health, 2017, 3: 1-12.
[13]
Lee S, Song J, Park DW, et al. Diagnostic and prognostic value of presepsin and procalcitonin in non-infectious organ failure, sepsis, and septic shock: a prospective observational study according to the Sepsis-3 definitions [J]. BMC Infect Dis, 2022, 22(1): 8.
[14]
Zhou Y, Liu Z, Huang J, et al. Usefulness of the heparin-binding protein level to diagnose sepsis and septic shock according to sepsis-3 compared with procalcitonin and C reactive protein: a prospective cohort study in China [J]. BMJ Open, 2019, 9(4): e026527.
[15]
Luka S, Golea A, Tat RM, et al. Biomarkers as predictors of mortality in sepsis and septic shock for patients admitted to emergency department: who is the winner? A prospective study [J]. J Clin Med, 2024, 13(19): 5678.
[16]
Mei Y, Li M, Li Y, et al. Early Warning models using machine learning to predict sepsis-associated chronic critical illness: a study based on the medical information mart for intensive care database [J]. Cureus, 2024, 16(8): e67121.
[17]
Liu W, Tao G, Zhang Y, et al. A simple weaning model based on interpretable machine learning algorithm for patients with sepsis: a research of MIMIC-Ⅳ and eICU Databases [J]. Front Med (Lausanne), 2021, 8: 814566.
[18]
Kim T, Tae Y, Yeo HJ, et al. Development and validation of deep-learning-based sepsis and septic shock early prediction system (DeepSEPS) using real-world ICU data [J]. J Clin Med, 2023, 12(22): 7156.
[19]
Oczkowski S, Alshamsi F, Belley-Cote E, et al. Surviving sepsis campaign guidelines 2021: highlights for the practicing clinician [J]. Pol Arch Intern Med, 2022, 132(7-8): 16290.
[20]
Prescott HC, Ostermann M. What is new and different in the 2021 surviving sepsis campaign guidelines [J]. Med Klin Intensivmed Notfmed, 2023, 118(Suppl 2): 75-79.
[21]
Zhou Y, Shi W, Wen Y, et al. Comparison of pathogen detection consistency between metagenomic next-generation sequencing and blood culture in patients with suspected bloodstream infection [J]. Sci Rep, 2023, 13(1): 9460.
[22]
Peri AM, Chatfield MD, Ling W, et al. Rapid diagnostic tests and antimicrobial stewardship programs for the management of bloodstream infection: what is their relative contribution to improving clinical outcomes? A systematic review and network meta-analysis [J]. Clin Infect Dis, 2024, 79(2): 502-515.
[23]
Wang C. Droplet Digital PCR rapid testing method for precise antibacterial diagnosis and treatment in suspected bloodstream infection patients: multicenter, prospective, stepped cluster randomized controlled trial [D]. Chengdu, Sichuan University, 2025.
[24]
Qin C, Zhang S, Zhao Y, et al. Diagnostic value of metagenomic next-generation sequencing in sepsis and bloodstream infection [J]. Front Cell Infect Microbiol, 2023, 13: 1117987.
[25]
Grumaz S, Grumaz C, Vainshtein Y, et al. Enhanced performance of next-generation sequencing diagnostics compared with standard of care microbiological diagnostics in patients suffering from septic shock [J]. Crit Care Med, 2019, 47(5): e394-e402.
[26]
Miao Q, Yuyan, Wang Q, et al. Microbiological diagnostic performance of metagenomic next-generation sequencing when applied to clinical practice [J]. Clin Infect Dis, 2018, 67(suppl_2): S231-S240.
[27]
Noitz M, Preining S, Jenny D, et al. The predictive value of clinical signs to identify shock in critically ill patients [J]. Diagnostics (Basel), 2025, 15(17): 2252.
[28]
Tschoellitsch T, Noitz M, Türk M, et al. The value of clinical signs as indicators of shock [J]. Intensive Care Med, 2023, 49(11): 1413-1415.
[29]
Lee SG, Song J, Park DW, et al. Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia: a retrospective cohort study according to the Sepsis-3 definitions [J]. Medicine (Baltimore), 2021, 100(7): e24835.
[30]
Flower L, Waite A, Boulton A, et al. The use of echocardiography in the management of shock in critical care: a prospective, multi-centre, observational study [J]. Intensive Care Med, 2024, 50(10): 1668-1680.
[31]
Hernández G, Ospina-Tascón GA, Damiani LP, et al. Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock: the ANDROMEDA-SHOCK randomized clinical trial [J]. JAMA, 2019, 321(7): 654-664.
[32]
Zampieri FG, Damiani LP, Bakker J, et al. Effects of a resuscitation strategy targeting peripheral perfusion status versus serum lactate levels among patients with septic shock. A Bayesian reanalysis of the ANDROMEDA-SHOCK trial [J]. Am J Respir Crit Care Med, 2020, 201(4): 423-429.
[33]
Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock [J]. N Engl J Med, 2001, 345(19): 1368-1377.
[34]
Monnet X, Julien F, Ait-Hamou N, et al. Lactate and venoarterial carbon dioxide difference/arterial-venous oxygen difference ratio, but not central venous oxygen saturation, predict increase in oxygen consumption in fluid responders [J]. Crit Care Med, 2013, 41(6): 1412-1420.
[35]
Wang G, Wang X. Host response and hemodynamics [Z]//Medical Journal of Peking Union Medical College Hospital, 2022, 13: 929-935.
[36]
王广健, 刘大为, 王小亭. 基于机体反应与血流动力学的重症新认知 [J]. 中华内科杂志, 2022, 61(3): 246-248.
[37]
Chalmers JD, Crichton ML, Goeminne PC, et al. Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline [J]. Eur Respir J, 2021, 57(4): 2100048.
[38]
Maneta E, Aivalioti E, Tual-Chalot S, et al. Endothelial dysfunction and immunothrombosis in sepsis [J]. Front Immunol, 2023, 14: 1144229.
[39]
Kushimoto S, Taira Y, Kitazawa Y, et al. The clinical usefulness of extravascular lung water and pulmonary vascular permeability index to diagnose and characterize pulmonary edema: a prospective multicenter study on the quantitative differential diagnostic definition for acute lung injury/acute respiratory distress syndrome [J]. Crit Care, 2012, 16(6): R232.
[40]
Beaubien-Souligny W, Rola P, Haycock K, et al. Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system [J]. Ultrasound J, 2020, 12(1): 16.
[41]
Permpikul C, Tongyoo S, Viarasilpa T, et al. Early use of norepinephrine in septic shock resuscitation (CENSER). A randomized trial [J]. Am J Respir Crit Care Med, 2019, 199(9): 1097-1105.
[42]
Kalimouttou A, Kennedy JN, Feng J, et al. Optimal Vasopressin initiation in septic shock: the OVISS reinforcement learning study [J]. JAMA, 2025, 333(19): 1688-1698.
[43]
Roggeveen LF, Guo T, Fleuren LM, et al. Right dose, right now: bedside, real-time, data-driven, and personalised antibiotic dosing in critically ill patients with sepsis or septic shock-a two-centre randomised clinical trial [J]. Crit Care, 2022, 26(1): 265.
[44]
Garnacho-Montero J, Gutiérrez-Pizarraya A, Escoresca-Ortega A, et al. De-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock [J]. Intensive Care Med, 2014, 40(1): 32-40.
[45]
De Waele JJ. Importance of timely and adequate source control in sepsis and septic shock [J]. J Intensive Med, 2024, 4(3): 281-286.
[46]
Sprung CL, Annane D, Keh D, et al. Hydrocortisone therapy for patients with septic shock [J]. N Engl J Med, 2008, 358(2): 111-124.
[47]
Steigbigel NH. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock [J]. Curr Infect Dis Rep, 2003, 5(5): 363-364.
[48]
李易, 王小亭, 尹万红. 基于重症超声可视化的休克规范诊疗: OPACCUS流程[J]. 中华内科杂志, 2025, 64(7):597-603.
[49]
Li Y, Zou T, Zeng X, et al. The effect of a new thinking guidance of OPACCUS for shock on the 30-day mortality: a multicenter, prospective, observational, cohort study [J]. Eur J Intern Med, 2025, 133: 39-47.
[50]
Komorowski M, Celi LA, Badawi O, et al. The artificial intelligence clinician learns optimal treatment strategies for sepsis in intensive care [J]. Nat Med, 2018, 24(11): 1716-1720.
[51]
Evans L, Rhodes A, Alhazzani W, et al. Executive summary: surviving sepsis campaign: international guidelines for the management of sepsis and septic shock 2021 [J]. Crit Care Med, 2021, 49(11): 1974-1982.
[52]
Yao L, Rey DA, Bulgarelli L, et al. Gene expression scoring of immune activity levels for precision use of Hydrocortisone in vasodilatory shock [J]. Shock, 2022, 57(3): 384-391.
[53]
Gao C, Lu X, Jiang Y, et al. Development of a gene panel for immune status assessment in sepsis [J]. Ann Intensive Care, 2025, 15(1): 170.
[54]
Scicluna BP, Cano-Gamez K, Burnham KL, et al. A consensus blood transcriptomic framework for sepsis [J]. Nat Med, 2025, 31(12): 4119-4130.
[55]
Rademaker E, van Amstel RBE, Bouhaddani SE, et al. Temporal robustness of biomarker-based classification algorithms for sepsis [J]. Intensive Care Med, 2025.
[56]
Giamarellos-Bourboulis EJ, Kotsaki A, Kotsamidi I, et al. Precision immunotherapy to improve sepsis outcomes: the ImmunoSep randomized clinical trial [J]. JAMA, 2025: e2524175.
[57]
De Backer D, Cecconi M, Chew MS, et al. A plea for personalization of the hemodynamic management of septic shock [J]. Crit Care, 2022, 26(1): 372.
[58]
Crippa IA, Salvagno M, Calabrò L, et al. Brain hemodynamics in septic patients [J]. Minerva Anestesiol, 2024, 90(9): 814-829.
[59]
Watchorn J, Huang D, Bramham K, et al. Decreased renal cortical perfusion, independent of changes in renal blood flow and sublingual microcirculatory impairment, is associated with the severity of acute kidney injury in patients with septic shock [J]. Crit Care, 2022, 26(1): 261.
[60]
Bachmann KF, Cotoia A, Blaser AR. Gastrointestinal function and nutritional interventions in septic shock [J]. Curr Opin Crit Care, 2025, 31(5): 599-607.
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