全身性感染与感染性休克

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1、全身性感染与感染性休克WhatisNew?安顺市人民医院严重全身性感染与感染性休克非特异性损伤引起的临床反应,满足2条标准:T>38Cor<36CHR>90bpmRR>20bpmWCC>12,000/mm3or<4,000/mm3or>10%杆状核SIRS=systemicinflammatoryresponsesyndromeSIRS及可疑或明确的感染Chest1992;101:1644.全身性感染伴器官衰竭顽固性低血压SIRSSepsisSevereSepsisSepticShock全身性感染(se

2、psis):流行病学MartinGS,ManninoDM,StephanieEatonS,etal.TheEpidemiologyofSepsisintheUnitedStatesfrom1979through2000.NEnglJMed2003;348:1546-54.全身性感染发病率的推算平均每年增加1.5%;相当于年增新发病例约22,875例AngusDC,etal.TheepidemiologyofseveresepsisintheUnitedStates:Analysisofincidence,ou

3、tcomeandassociatedcostsofcare.全身性感染临床试验对照组的病死率全身性感染的医疗费用2000年ICU医疗费用的40%欧洲每年花费€7,600,000,0001美国每年花费$16,700,000,0002DaviesAetal.Abstract581.14thAnnualCongressoftheEuropeanSocietyofIntensiveCareMedicine,Geneva,Switzerland,30September-3October2001AngusDC,Linde

4、-ZwirbleWT,LidickerJ,etal.EpidemiologyofseveresepsisintheUnitedStates:Analysisofincidence,outcome,andassociatedcostsofcare.CritCareMed2001;29:1303–1310SurvivingSepsisCampaign:Why?过去5年间阳性结果的干预措施严重全身性感染与感染性休克EGDT激素APC小潮气量通气策略危重病患者的一般治疗镇静严格血糖控制脱机方案SurvivingSep

5、sisCampaign(SSC)GuidelinesforManagementofSevereSepsisandSepticShockDellingerRP,CarletJM,MasurH,GerlachH,CalandraT,CohenJ,Gea-BanaclocheJ,KehD,MarshallJC,ParkerMM,RamsayG,ZimmermanJL,VincentJL,LevyMMandtheSSCManagementGuidelinesCommitteeCritCareMed2004;32:85

6、8-873IntensiveCareMed2004;30:536-555availableonlineatwww.springerlink.comwww.sccm.orgwww.sepsisforum.comTheguidelineswerepublishedinbothCriticalCareMedicineandinIntensivecareMedicine,andareavailableon-lineSurvivingSepsisCampaignGuideline最初复苏(initialresuscit

7、ation)诊断(diagnosis)抗生素治疗(antibiotictherapy)感染源控制(sourcecontrol)液体治疗(fluidtherapy)升压药物(vasopressors)强心药物(inotropictherapy)激素(steroids)活化蛋白C(recombinanthumanactivatedproteinC)血液制品(bloodproductadministration)ARDS机械通气(mechanicalventilationofsepsis-inducedALI/AR

8、DS)镇静(sedation,analgesia,andNMBinsepsis)血糖控制(glucosecontrol)肾脏替代(renalreplacement)碳酸氢钠(bicarbonatetherapy)DVT预防(DVTprophylaxis)应激性溃疡预防(stressulcerprophylaxis)考虑限制支持治疗水平(considerationforlimitationofsupp