Activated Protein C for Sepsis

作者：Toussaint Susanne; Gerlach Herwig^*

来源：New England Journal of Medicine, 2009, 361(27): 2646-2652.

DOI：10.1056/NEJMct0808063

A 55-year-old man is brought to the emergency department with abdominal pain, fever (temperature, 102.9 degrees F), and dyspnea. His medical history includes an appendectomy 8 years earlier. Abdominal radiography shows free air as well as signs of small-bowel ileus. An emergency laparotomy is performed. Intraoperatively, a lower-small-bowel perforation is identified, with evidence of peritonitis. Partial ileal resection with end-to-end anastomosis is performed. Treatment with broad-spectrum antibiotics is initiated; blood cultures grow typical Enterobacteriaceae ( Escherichia coli and Proteus mirabilis) and Enterococcus faecium. Septic shock with hypotension requiring vasopressor support, hypoxemia requiring mechanical ventilation, and renal dysfunction develop, with an elevated serum lactate level. The patient's Acute Physiology and Chronic Health Evaluation (APACHE) II score ( see the Supplementary Appendix, available with the full text of this article at NEJM.org) is 27. Results of clotting studies are normal, and no clinical bleeding is detected. The surgeon and the intensivist decide that treatment with activated protein C is indicated.

• 出版日期2009-12-31