[Contemporary views on the problem of sepsis].

Abstract

Sepsis is due to its lethality, which varies round 25%, one of the major problems of contemporary clinical medicine. Classical therapeutic approaches, i.e. chemotherapy, surgical elimination of foci and intensive therapy focused on maintenance of vital functions have obviously reached the limit of effectiveness beyond which they are unable to advance any further. Therefore great efforts are devoted to research into pathogenetic mechanisms involved in sepsis with the aim to use their effect to improve therapeutic results. In the submitted paper the authors analyze the definition of sepsis, explain the concept of the syndrome of systemic inflammatory response and summarize the contemporary state of knowledge of the pathogenesis. A review of structures and mechanisms involved in the genesis and development of sepsis (complement, factor XII, macrophage, endothelial cell, polymorphonuclear leucocyte, thrombocyte etc.) is supplemented by a list of substances which act as mediators of inflammations. The conclusions for practice summarize contemporary therapeutic possibilities, i.e. classical means as well as more recent approaches (colony stimulating factors, haemodiafiltration, antithrombin III, monoclonal antibody against endotoxin). The authors review briefly therapeutic means which are developed at present and which should make it possible to interfere actively with the pathogenesis of the disease.