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T16.Sepsis

T16.Sepsis

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Published by Ion Gorbuli

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Published by: Ion Gorbuli on May 15, 2013
Copyright:Attribution Non-commercial

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05/15/2013

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Sеpsisul.Еtiologialpatogеnza, diagnostiсa'abloulсliniс,tratamеntul,profiaсtiсa.PAnй a momеntulaсtualsеpsisulqi qoсulsеptiсеstесauzaprinсipalйal dесеsuluipaсiеn}ilornsесliilеdе rеanimarеqitеrapiеintеnsiv6.Мortalitateaсonform rеlatбrilora maimultorсrntre sanitaгеdin lumе rйm6nе s6 sе mеn}inЁ anivеlulaproximat\у24Yo n sеptiсеmiеqiЗ5%ngoсulsеptiс.De еxеmplu,n Gеrmaniaanualdесеdеaze75000pеrsoanеdin calzasеptiсеmiei,сe еstееgal сu.сauzеlеetalе nсaz dеinfarсt mioсardiс.n Еuropa anualse diagnostiс6proximativ 500000canlri dе sеptiсеmie,auuncazla fiесarе1000 dеpaсiеn1ipitaliza1i.nсеprivеqtеratаmеnfulunuipaсiеntсusеptiсеmiееstе de6orimai еlevatdес6ttratamеntulunеi altеsitua1iiсritiсе.Tеrmеnul dе,,sеpsis''a fost introdusс6trе Aristotеl insесolul Iv. Е1еxpliсa sеpsisul сao intoхiсaliеaorganismului сuproduselеdeputrifiсarесе sеpеtrесn orgаnism.La momеntuldе aziеxisti alt6 dеfini1iе a sеpsisului:-еstе opatologiеinflamatorеsevеrЁ,ca:шzatl difеritеmiсroorganismе saua toxinеlor lorсarе arе omanifеstareсliniс6 identiсi indifеrеntde agеntulprovoсatoг.Prinсipaladiferеnt6 al sеpsisului este сЁ еl еstе non.сontagiosginu arеperioadёinсubarе.InflamarЁapoatеfi asoсiataсuprеvalarеaeaсtiilorde apЁrarе'loсaleсu manifestйri ipiсе loсalе si o reaсliеmodеrataa organеlorsisistеmеlor.Intr.o agrеsiegravandifirеnt dесе originеsе dеzvolta oreaсtiesistеmiсa,asoсiata u dеrеglarraorganеlorgisistеmelordeimportan{a ital6. Aсеast6 rеaс}iеgrav6sе numеadifеrit:starе septiоЁ;sеpsis.sindrom; az6 ittt]rialй sеpsisuluifebr6supurativ-rеzorbtiv6;sepsis;еndotoxiсoza.Complеxitatеarоblеmеidеzvoltйriisеpsisuluiеstесйnumai n 45_48%dе сazuriсliniсе sedеpistеazlobaсtеriеmie.Cliniс
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еstе mрosibil dе difеrеnliato starеpatologiс6рrovoсat6o infесfiеsistеmiс6sauprodusйоdеzintеgrarеisularе vastй.Dinaсеast6, auz6,in 1992laCоnfеrinlaIntеrnalionalйеConsеnsusalColegului Amеriсanal mеdiсilororaсaliqtiiSoсiеt61ii е Тratarе l BolnavilornSitua1iiCritiсе(AmеriсanCollеdgе ofChеstPhysiсians/Soсiеty of Critiсa| СarelМеdесinе ConsеnsusConfеrеns),qidin сauzaunifiсйrii tеrminologiеi nseptiсemiе a fost introdus tеrmеnul ,,SindromulR6spunsInflamatorSistеmiс''_SIRS(sYsTЕМICINFLAMATORYRЕSPONS
sYNDRoМ).'.
Ce еstе,nprinсipiunou la еtapaaсfualйpеntrua in!еlеgeproblеmasеpsisului? Gratieprogrеsеlordinbiologiamolесularй,imunologiegia bioсhimiei a dеvеnitсunosсut,,deтloltarеaеz6rilororgano-sistеmiсеuntеgatedepenеtrarеaonсontrolabilialmediatorilorproinflamatoridin foсarulprimarin s6nge,сarеprovoaсёaсtivarеaultеrioarё a maсrofagilor organelorqi!еsuturilorсu еlibеrarrasubstantelorroinflamatoriianalogiсе.Lamomеntul aсtual еstе есunosсut 6sеpsisulnu trebuieсonsidеrat a un simplu rеzultаtdе aсtiunеdirесtЁal miсroorganismuluiasupramaсroorganismului,ar trebuiесonsiderata dеreglarеasistemului imun, сare asurvеnitnfazastЁrii dе hiperaсtivatiе(,,fazadehiperinfl ama!iе'')pane|a faza dе defiс t imunitar(,,munopara|ezie',.Pеntru mеtabolismul оrganismuluipaсientuluiсu sеpsis еstеapliсatйnotiuneade,,autoсanibalism'' eptiс.Suntmai multе dеfini1ii aSЕРSISULUI:1. Sepsisul-еstеunproсеsnfесlios nеspесifiсfoartеgravсеsrdeтto|tdfonul rеaсtivitйtisсhimbatеaorganismului.(М.Kuzin).2.Sepsisul_еstео maladiеnfесlioasб'gravё,,rovoсatйde difеri1igеrmеni patogеnigiеndotоxinеlеor,сarеsе сaraсtеrizeazl'сuun
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dtabiouсliniсasеmdndtoгidеzмo|tdе fonui unеi еaсtivitйtimосjilсatе.V.Struсiсov.j"Ser:slsиfiliг.rrgiсаlеstео il-ia]adiееnеraiizati ravй'Сa'i.,apДгut upaргеZеntаnuifосarprilnardе ntЪс1iе,еtbnulшr"rеirеaсtivitй1iеrеglatеinесеsitйтatamеnthirurgiсalосal9iintеnsivgenеral.ЕtiologiaProvoсatorii еpsisuluiotfidifеri1igеnlimiсrobiеni. n сulturilеsangvinе оlесtatе е apaсiеnliiсu sеpsisdе obiсеisе dеtегminйstrеptoсoсi,tafilосoсi,pnеumoсoсi,qimai rarеshеrihia oli. inunеlеcazurisе stabilegtеlorЁ miхt6.Ca sursеdе infесliipotsегvi:abсеsе,flеgmoanе,mastitе,pеritоnitе9iсhiarun furunсulbanal aprimavеdеrе.in ultimul timp a сrеsсut ata miсroorganismеlorram,-,,Пsеpsis,dar45 |asut6din sеpsis йm6nе otuqisеama tafiloсoсilor.Aсtivitatеapatоgеniсiastafiloсoсilorsе datorеqtе apaсiteliiproduсliеa difеritorsubstan!е oxiсе_hеmolizi-nilor, еuсotoxinеlor,еrmonесrotoxin,еntеrotoxin. luslaaсеastatafilo-сoсiiсontin faсtori dееlеvarеalсapaсitй1ii е nvazivitatеal miсroorganis.mеlor: oagulaza,gialuronidza, |eucotoхina.orlilеntrarеpеntrustafi oсoсi sеrvеsсplЁgiler6spAnditе,n dеosеbiсuprezenldе masenесrotiсеqidеregliridе еvaсuarеa еxudatuluipurulеnt.Pеntru sеpsisulstafiloсoсiс еstесaraсtеristiсbсesеmеtastatiсеndеpйrtatеipnеumoniisеptiсе.in ultimul timpnеtiоlogia sеpsisuluidreptul a еxistеn!6l сapйtibaсtеroizii_miсroorganismеram,-',pоtdесlanga еpsisul.n ultimii40-50ani n miсroflora dесlangatоaе sеpsisau survеnitmodifiсйriеsеnlialе.Un rоl dеosеbitimportant еrеvinеgегmеnilоrgramnеgativi(eshеriсhiaoli,psеudоmonas rroginosa,lеbsiеlla,prоtеus).Unul dinfaсtorii еsеnlial dе impоrtantin dеоlanqarеaеpsisuluiеstеlipopolisahariduldinmеmbrana еlular6a|gеrmеnelorramnegativi,

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