Wikipedia:WikiProject Medicine/Translation task force/RTT/Simple sepsis
<!-- Definition and symptoms -->
Sepsis (/ˈsɛpsɨs/) is whole-body inflammation caused by an infection.[1] Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion.[2] There may also be symptoms related to a specific infection such as a cough with pneumonia or burning with urination with a kidney infection. In the very young, old, and people with a weakened immune system, there may no symptomcs of a specific infection and the body temperature may be low or normal rather than high.[3] Severe sepsis is sepsis causing poor organ function or insufficient blood flow. Insufficient blood flow may be evident by low blood pressure, high blood lactate, or low urine output. Septic shock is low blood pressure due to sepsis that does not improve after reasonable amounts of intravenous fluids.[1]
<!-- 定義與症狀 -->
’’’敗血症’’’（{{Lang-en|Sepsis}}）指的是由於[[感染]]所引起的全身性[[炎症|發炎]]的嚴重疾病[1]。常見的臨床症狀包括發燒、[[過度換氣症候群|呼吸頻率]]和[[心跳过速|心跳加速]]，以及意識不清[2]。有時患者也會發生特定的臨床症狀，如因[[肺炎]]引起的咳嗽，或因為{{Link-en|腎臟感染|Pyelonephritis}}所導致的{{Link-en|排尿灼熱感|Dysuria}}。若敗血症發生於年長者、年紀幼小或{{Link-en|免疫能力貧弱|Immunodeficiency}}之患者，則可能會沒有特定的感染症狀，亦可能表現出[[低体温症|體溫過低]]或維持正常（一般發炎時，組織的溫度會升高）的特殊症狀[3]。’’’嚴重的敗血症’’’會導致供應組織的血流不足甚至{{Link-en|器官衰竭|Organ_dysfunction}}。血流不足的原因可能是由於敗血症引起的[[低血壓]]、高血[[乳酸]]或是[[寡尿|低排尿量]]所導致。敗血症引起的低血壓有可能會導致’’’感染性休克’’’，此一休克症狀並無法藉由靜脈輸液的方式有所改善[1]。
<!-- Cause and diagnosis-->
Sepsis is caused by an infection triggering an immune response. The infection is most commonly by bacteria, but can also be by fungi, viruses, or parasites.[3] Risk factors include: the young, the old, people with poor immune systems such as from cancer or diabetes, as well major trauma and burns.[2] Common locations for the primary infection include: lungs, brain, urinary tract, skin, and abdominal organs. Diagnosis is based on at least two systemic inflammatory response syndrome (SIRS) criteria due to a presumed infection. Blood cultures are recommended preferably before antibiotics are started; however, infection of the blood is not required for the diagnosis.[3] Medical imaging should be done looking for the possible location of infection.[1] Other potential causes of similar symptoms include: anaphylaxis, adrenal insufficiency, low blood volume, heart failure, and pulmonary embolism among others.[3]
<!-- 成因與診斷 -->
敗血症的定義為由於感染所引起的{{link-en|全身性發炎反應症候群|Systemic_inflammatory_response_syndrome}}（{{lang-en|Systemic inflammatory response syndrome, SIRS}}），亦即滿足後列四項中至少兩項條件，加上存在感染的證據：體溫小於36°C或大於38°C、心跳每分鐘大於90次、呼吸頻率每分鐘大於 20次或血液中二氧化碳分壓小於32毫米汞柱、血液中白血球數量每毫升大於12000或小於4000[8]。感染的病原體多半為[[細菌]]，但亦可能被[[黴菌]]、[[病毒]]或[[寄生蟲]]侵入體內而引發敗血症[3]。高危險族群包括：年長者、年紀幼小之個體，以及因其他疾病 （如：[[癌症]]、[[糖尿病]]、{{link-en|重大創傷|major_trauma}}或[[灼傷|燒傷]]）導致[[免疫功能]]不足之患者[2]。敗血症常見的原發性感染來自下列位置：肺、腦、[[泌尿系統|泌尿道]]、皮膚以及[[腹|腹腔器官]]。{{link-en|血液培養|Blood culture}}可診斷出特定的病源菌，建議需在施打[[抗生素]]之前就取得血液檢體以提高陽性率，然而{{link-en|血液培養陽性|bacteremia|菌血症}}並非診斷敗血症的必要條件[3]。[[醫學影像]]亦可進一步分析且定位受到感染的病灶組織[1]。其它可造成類似敗血症症狀的鑑別診斷包括：[[全身型過敏性反應|嚴重全身過敏性反應]]、{{link-en|腎上腺皮質功能不全|Adrenal_insufficiency}}、[[血容量減少|低血容量]]、[[心臟衰竭]]以及[[肺栓塞]]等等[3]。
<!-- Treatment -->
Sepsis is usually treated with intravenous fluids and antibiotics. This is often done in an intensive care unit. If fluid replacement is not enough to maintain blood pressure, medications that raise blood pressure can be used.Mechanical ventilation and dialysis may be needed to support the function of the lungs and kidneys, respectively.[2] To guide treatment, a central venous catheter and an arterial catheter may be placed. Other measurement such as cardiac output and superior vena cava oxygenation saturation may also be used. People with sepsis need preventive measures for deep vein thrombosis, stress ulcers and pressure ulcers, unless other conditions prevent this. Some might benefit from tight control of blood sugar levels with insulin.[1] The use of corticosteroids is controversial.[4] Activated drotrecogin alfa, originally marketed for severe sepsis, has not been found to be helpful, and was withdrawn from sale in 2011.[5]
<!-- 治療 -->
敗血症常規治療包括[[靜脈輸出|
靜脈輸液]]及[[抗细菌药|抗生素]]治療，通常需要在[[加護病房]]內進行生命徵象監測。{{link-en|升壓劑藥物|Antihypotensive_agent}}使用於輸液無法有效維持血壓時，而{{link-en|呼吸器Mechanical_ventilation}}及[[透析]]治療能夠減輕肺臟以及腎臟的負擔[2]。[[中央靜脈導管]]及{{link-en|動脈導管|Arterial_catheter}}可連續監測血行動力學，提供治療上即時的處置，同時便於升壓藥物的使用。{{Link-en|心輸出量|Cardiac output}}以及{{link-en|上靜脈血氧飽和度|Oxygen_saturation|血氧飽和}}也是應密切注意的數據，視情況需要採取必要處置以預防[[深静脉血栓|靜脈栓塞]]、上消化道{{link-en|壓力性潰瘍|stress_ulcers}}及[[褥瘡]]的發生。使用[[胰島素]]嚴格控制[[血糖]]對於部分敗血症病患是有好處的[1]。[[類固醇]]使用尚有爭議[4]。活化蛋白質C（具有抗凝血與抗發炎之效果，常使用 在嚴重敗血症合併多重器官衰竭患者）及歷經十年臨床使用的試驗評估藥物{{link-en|除栓素|drotrecogin_alfa}}（{{ang-en|Xigris或drotrecogin_alfa(activated) , rhAPC}}）
[譯註1]，因未能顯著降低敗血病患的死亡率，[[美國食品和藥物管理局]]與歐洲藥物管理局（{{lang-en|European Medicine Agency, EMA}}）在2011年10月25日撤銷該藥物的銷售許可[5]。
<!-- Prognosis, epidemiology and history -->
Outcomes depend on the severity of disease with the risk of death in sepsis being as high as 30%, severe sepsis as high as 50% and septic shock as high as 80%.[6] The total number of cases worldwide is unknown as there is little data from the developing world.[6] Estimates are that it affects millions of people a year.[1] In the developed world about 0.2 to 3 per 1000 people gets sepsis yearly or about a million cases per year in the United States.[6][7] Rates of disease have been increasing.[1] Sepsis is more common among males than females.[3] The terms septicemia and blood poisoning, refered to the microorganisms or their toxins in the blood and are no longer commonly used.[8][9] The condition has been described at least since the time of Hippocrates.[9]
<!-- 預後、流行病學與歷史-->
預後決定於疾病嚴重度，其中敗血症死亡率可達30%，重度敗血症死亡率達50%，而敗血性休克死亡率則高達80%[6}。估計每年全球有數百萬例敗血症發生，而確切統計數字，受到[[發展中國家]]資料並不完整而無法確定[6]。在已發展國家如美國，年˙發生率約每1000人0.2至3人，即每年有一百萬例敗血症[6][7]。疾病發生率仍在上升中[1]。男性多於女性[3]。敗血症的另一字（{{lang-en|septicemia}}）以及毒血症（{{lang-en|blood poisoning}}）是描述血液中的微生物以及其產生的毒素，現在這兩種描述都已經十分少用[8][9]。敗血症的病情至少在[[希波克拉底]]的時代就已經可見到相關描述[9]。
敗血症(Sepsis)是一種血液中毒的病症。患者多是免疫系統比較差的人，主因則是身體某些部位的細菌擴散至血液，細菌在血液中大量繁殖並且產生毒素，令人體器官功能受損，並會在病發時衰竭。但是，有一部份的敗血症患者仍然找不到原發病灶。