分层决策与全程管理——《拯救脓毒症运动：脓毒症与感染性休克治疗国际指南（2026）》解读
Stratified Decision-making and Continuum-of-care Management: an Interpretation of the Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock (2026)
肖璐 1许欣宜 1缪长宏 1王元翀 1李桂伟1
作者信息
- 1. 天津市天津中医药大学第一附属医院南院急症部;中医国家临床医学研究中心
- 折叠
摘要
《拯救脓毒症运动：脓毒症与感染性休克治疗国际指南（2026）》（以下简称“SSC 2026 指南”）强调基于感染概率、休克状态、患者异质性和疾病阶段的分层决策。本文结合临床证据与我国急诊、重症医学实践，对指南主要更新进行解读。SSC 2026 指南弱化快速序贯器官衰竭评估（qSOFA）的单一筛查地位，强调早期预警评分、脓毒症可能性四层分级及多学科快速响应流程；抗感染治疗更加突出感染概率和休克状态分层，强调依据危险因素选择性覆盖多重耐药菌、真菌和厌氧菌，并强化抗菌药物降阶梯治疗；血流动力学方面强调动态复评指导液体复苏，新增老年患者较低平均动脉压目标和复苏后主动液体清除推荐。SSC 2026 指南的核心价值在于推动脓毒症救治从“快速反应”转向“精准收放”和全程管理。临床实施中，应加强多学科快速响应、抗菌药物全程管理、血流动力学动态复评及出院后随访，推动指南推荐转化为连续、规范且可评价的诊疗路径。
Abstract
The Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock (2026) (hereinafter referred to as the "SSC 2026 Guidelines") emphasize stratified decision-making based on the probability of infection, shock status, patient heterogeneity, and disease stage. This article reviews the major updates of the guidelines, drawing on clinical evidence and emergency and critical care practice in China. The SSC 2026 Guidelines de-emphasize the quick Sequential Organ Failure Assessment (qSOFA) score as a standalone screening tool, instead highlighting early warning scores, a four-tier stratification of sepsis probability, and multidisciplinary rapid response protocols. Antimicrobial therapy is further stratified by the probability of infection and shock status, emphasizing selective coverage of multidrug-resistant organisms, fungi, and anaerobes based on risk factors and reinforcing antimicrobial de-escalation. For hemodynamic management, the guidelines emphasize dynamic reassessment to guide fluid resuscitation and introduce new recommendations for a lower mean arterial pressure target in elderly patients and for active fluid removal following resuscitation. The principal contribution of the SSC 2026 Guidelines lies in shifting sepsis care from a paradigm of "rapid response" to one of "precision titration" and continuum-of-care management. Clinical implementation should prioritize multidisciplinary rapid response, antimicrobial stewardship throughout the treatment course, dynamic hemodynamic reassessment, and post-discharge follow-up, to translate guideline recommendations into continuous, standardized, and auditable clinical pathways.关键词
脓毒症/感染性休克/指南解读/抗菌药物管理/液体复苏/全链条管理Key words
Sepsis/Septic shock/Guideline interpretation/Antimicrobial stewardship/Fluid resuscitation/Continuum-of-care management引用本文复制引用
肖璐,许欣宜,缪长宏,王元翀,李桂伟.分层决策与全程管理——《拯救脓毒症运动：脓毒症与感染性休克治疗国际指南（2026）》解读[EB/OL].(2026-10-26)[2026-10-30].https://chinaxiv.org/abs/202610.00207.学科分类
内科学
