Adrenocortical hormone application in view of the changes in the concept of diagnosis and treatment of sepsis
Yang Jiangang1, Wang Xu2, Yang Yubin1, Yang Ce3
1Department of Intensive Care Unit, the Third Hospital of Datong, Datong 037008, China; 2Department of Emergency, the Second Affiliated Hospital of Medical College in Zhejiang University, Hangzhou 310009, China; 3State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical Centre of PLA, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing 400042, China
Abstract：Sepsis is a life-threatening organ dysfunction caused by a pathogenic microbial infection. Due to the complexity of the pathophysiological mechanism, the definition of its concept had undergone three major revisions since 1991. But it remains difficult to reach a broad consensus. Especially in the context of "Surviving Sepsis Campaign", the high incidence and mortality, the lack of specific drugs, and many disappointing empirical treatment measures indicate that there is a long way to explore the pathogen-independent mediator responses in sepsis. As an important effector of the neuro-endocrine-immune regulatory network, the adrenal gland participates in the nonlinear and complex regulation of sepsis via responsive hormones by linking central stress signals and local microenvironmental responses. The early identification and replacement therapy of adrenal dysfunction and the rerecognition in the environment of sepsis disorder are undoubtedly the key aspects in the diagnosis and treatment of sepsis. Growing evidences of international clinical studies on adrenocortical hormones and pending recommendations in the past 30 years have further shown their therapeutic capacity. To this end, based on the 4P (preventive, predictive, personalized, participatory) medical model in translational medicine, this paper analyzes the diagnosis and treatment of adrenalcortical hormones from the definition and connotation of sepsis, and elaborates the theory of microenvironmental regulation of neuro-endocrine-immune network from the endogenous and exogenous adrenalcortical hormones. We try to further analyze the bottlenecks and confusion from the diagnosis and treatment of sepsis via adrenocortical hormones (type, dosage, single and combined treatment, time window), aiming to provide useful reference and enlightenment for the application of adrenocortical hormones in sepsis.
杨建钢 王旭 杨玉彬 杨策. 从脓毒症诊治观念变迁看肾上腺皮质激素的应用[J]. 中华诊断学电子杂志, 2019, 7(1): 1-6.
Yang Jiangang1, Wang Xu2, Yang Yubin1, Yang Ce3. Adrenocortical hormone application in view of the changes in the concept of diagnosis and treatment of sepsis. zhzdx, 2019, 7(1): 1-6.
