124.2 📚 國考版

📖 中文概念說明：國考重點集中在(1) Sepsis-3 定義、(2) qSOFA / SOFA cutoffs、(3) 1-hr bundle 內容、(4) empirical 廣譜選擇、(5) PCT 解讀這五大塊。題型多為情境題 (case-based)，需要從病史 + 生命徵象 + 檢驗一路推到 empirical regimen。最常出錯的點是把 SIRS 跟 Sepsis-3 搞混 (SIRS 是 1992 舊定義已被取代)、以及忘記 septic shock 必須包含「fluid 給夠仍低血壓需 vasopressor」這項條件。下表為高頻考點濃縮。

124.2.0.1 📌 Quick Recall

項目	數字 / 規則
qSOFA ≥ 2	RR ≥ 22, AMS, SBP ≤ 100
Severe sepsis lactate	> 2 mmol/L
Septic shock	Lactate > 2 + vasopressor + MAP < 65 (despite IV fluid)
PCT bacterial cut	> 0.5 ng/mL
Sepsis 1-hr bundle	Lactate + Cultures + Antibiotics + IV fluid + Vasopressor
CAP 治療長度	5 days (mild) — 7-10 days (severe)
Empirical 廣譜首選 (HAI)	Pip-tazo or cefepime ± vancomycin (MRSA) ± aminoglycoside

124.2.0.2 必背 — Sepsis-3 (2016) 定義

• Sepsis = life-threatening organ dysfunction caused by dysregulated host response to infection
  • SOFA score ↑ ≥ 2 (vs baseline)
• Septic shock = sepsis + persisting hypotension requiring vasopressors to maintain MAP ≥ 65 + lactate > 2 despite adequate fluid resuscitation

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