Journal of Experimental and Clinical SurgeryJournal of Experimental and Clinical SurgeryВестник экспериментальной и клинической хирургии2070-478X2409-143XVoronezh State Medical University named after N.N. Burdenko4710.18499/2070-478X-2015-8-3-301-309Original articlesОригинальные статьиSepsis: Modern ParadigmСепсис: современная парадигмаКарсановА.M.

Ph.D., Assistant of the Department ofthe Surgical Diseases №3 NOSMA; Oncologist Nonstate operated “Passenger Terminal Hospital at theVladikavkaz Station of the JST “Russian Railways”

Ph.D., Assistant of the Department ofthe Surgical Diseases №3 NOSMA; Oncologist Nonstate operated “Passenger Terminal Hospital at theVladikavkaz Station of the JST “Russian Railways”

karsan@inbox.ruМаскинС.С.

 MD., Prof., Chief of the Department ofthe Hospital Surgery VSMU

MD., Prof., Chief of the Department ofthe Hospital Surgery VSMU

maskins@bk.ruКарсановаЗ.O.

Ph.D., Surgeon Non-state operated“Passenger Terminal Hospital at the Vladikavkaz Station of the JST “Russian Railways”

Ph.D., Surgeon Non-state operated“Passenger Terminal Hospital at the Vladikavkaz Station of the JST “Russian Railways”

z.karsanova@mail.ruNorth-Ossetian State Medical Academy, 40 Pushkinskaya Str., Vladikavkaz, 362019, Russian FederationNorth-Ossetian State Medical Academy, 40 Pushkinskaya Str., Vladikavkaz, 362019, Russian Federation Non-state operated “Passenger Terminal Hospital at the Vladikavkaz Station of the JST “Russian Railways”, 16 Chkalov Str., Vladikavkaz, 362002, Russian FederationNon-state operated “Passenger Terminal Hospital at the Vladikavkaz Station of the JST “Russian Railways”, 16 Chkalov Str., Vladikavkaz, 362002, Russian FederationVolgograd State Medical University, 1 Pavshikh Bortsov Sq., Volgograd, 400131, Russian FederationVolgograd State Medical University, 1 Pavshikh Bortsov Sq., Volgograd, 400131, Russian FederationNon-state operated “Passenger Terminal Hospital at the Vladikavkaz Station of the JST “Russian Railways”, 16 Chkalov Str., Vladikavkaz, 362002, Russian FederationNon-state operated “Passenger Terminal Hospital at the Vladikavkaz Station of the JST “Russian Railways”, 16 Chkalov Str., Vladikavkaz, 362002, Russian Federation24092015833013092504201625042016Copyright ©; 2015, ., ., .Copyright ©; 2015, Карсанов А., Маскин С., Карсанова З.2015., ., .Карсанов А., Маскин С., Карсанова З.http://creativecommons.org/licenses/by-nc-nd/4.0https://vestnik-surgery.com/journal/article/view/47

The article presents the current guidelines for the diagnosis and treatment guidelines for severe sepsis (SS) and septic shock (SSh), reflecting the interdisciplinary experience of experts in more than 30 associations, united in the movement «Surviving Sepsis Campaign».

For the diagnosis of sepsis is recommended to focus on advanced clinical and laboratory criteria and is not recommended to use a higher level of procalcitonin or other biomarkers as a diagnostic tool for the verification of the vehicle.

With regard to the treatment program accented allocated an initial and subsequent stages of treatment. The purpose of the initial phase is to achieve the target parameters of hemodynamics and oxygen status, which is implemented by hemodynamic and respiratory support, adequate surgical control of the focus of infection and the choice of the optimal mode of antibacterial therapy.The highest level of reliability has a number of provisions of the treatment program at SS and SSh: crystalloid infusion solutions are the choice; hydroxyethyl starches should not be used for infusion therapy; norepinephrine is the vasopressor of choice; dobutamine is regarded as the drug of choice to increase cardiac output; restrictive strategy in relation to the use of corticosteroids, blood products, and muscle relaxants; expansion of recommendations for respiratory support; the need for hypo- and normokaloric combined with enteral nutritional support regime; glycemic control should start at the level of blood glucose above 180 mg / dL, in order to achieve the target level of ≤110 mg / dL; continuous renal replacement therapy and intermittent hemodialysis are equivalent in patients with acute renal failure; obligatory daily pharmacoprophylaxis venous thromboembolic complications with the preferred use of low molecular weight heparins and stress gastric ulcer proton pump inhibitors.

В статье представлены современные рекомендации по диагностике и принципам лечения тяжелого сепсиса (ТС) и септического шока (СШ), отражающие междисциплинарный опыт экспертов более чем 30 ассоциаций, объединившихся в движение «Surviving Sepsis Campaign». 

Для диагностики сепсиса рекомендовано ориентироваться на расширенные клинико-лабораторные критерии и не рекомендовано использовать повышенный уровень прокальцитонина, либо другого биомаркера в качестве диагностического инструмента для верификации ТС.

Применительно к лечебной программе акцентированно выделяется инициальный и последующий этапы лечения. Целью инициального этапа является достижение целевых параметров гемодинамики и кислородного статуса, что реализуется посредством гемодинамической и респираторной поддержки, адекватным хирургическим контролем над очагом инфекции и выбором оптимального режима антибактериальной терапии.

Наивысший уровень надежности имеет ряд положений лечебной программы при ТС и СШ: кристаллоиды являются инфузионными растворами выбора; гидроксиэтилкрахмалы не должны использоваться для инфузионной терапии; норадреналин является вазопрессором выбора; добутамин рассматривается как препарат выбора для увеличения сердечного выброса; ограничительная стратегия в отношении использования кортикостероидов, препаратов крови и миорелаксантов; расширение рекомендаций по респираторной поддержке; необходимость гипо- и нормокалорического комбинированного с энтеральным режима нутриционной поддержки; протоколизированный контроль гликемии должен начинаться при уров-

не глюкозы крови выше 180 мг / дл, для достижения целевого уровня ≤110 мг / дл; непрерывная заместительная почечная терапия и прерывистый гемодиализ эквивалентны у пациентов с острой почечной недостаточностью; обязательна ежедневная фармакопрофилактика венозных тромбоэмболических осложнений с предпочтительным применением низкомолекулярных гепаринов и стрессовых язв желудка ингибиторами протонной помпы.

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