《严重感染治疗策略》PPT课件

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1、严重感染的抗感染策略重症感染的重要性细菌耐药机制及ICU细菌流行情况重症感染的治疗策略－感染灶的充分引流－早期经验性治疗－正确的目标性治疗内容提要Sepsis=Infection+SIRS细菌侵入临床体征infection损伤SIRSsepsisseveresepsissepticshockMODS/MOF感染过程ImpactofadequateempiricalantibiotictherapyontheoutcomeofpatsadmittedtoICUwithsepsisCCM,2003,31:

2、2742Annualincidenceofseveresepsis:3cases/1,000Kill:1,400peopleworldwide/d25people/hMoreover,No.ofsepsispatsisprojectedtoincreaseby1.5%perannum严重感染的病死人数超过乳腺癌、直肠癌、结肠癌、胰腺癌和前列腺癌的总和严重感染vsAMI:发病率相同，病死率明显高SepsisinworldwideSurvivingSepsisCompaign拯救Sepsis运动巴塞罗那宣

3、言ESICMSCCMISF2002年10月2日,西班牙全球Sepsis的发病率和死亡率均很高，耗费大量的人力物力呼吁全球医务专业人员和组织、政府、卫生机构甚至公众支持该行动ImprovesurvivalinseveresepsisAIM:5年内Sepsis死亡率减少25%第一阶段/PhaseIDevelopguidelinesBedsidecliniciancouldusetoimproveoutcomeinseveresepsisanssepticshock第二阶段/PhaseIIESICMSCCM

4、ISFAACCN/ACCP/ACEP/ATS/ANZICS/ESCMID/ERS/SIFGuidelinesforsepsis.IntensiveCareMed2004,30:536-555Guidelinesformanagementofseveresepsis/septicshockInitialresuscitation:earlygoal-directedtherapyDiagnosis:appropriatecultureAntibiotictherapy:Earlybroad-spectr

5、um,reassessed2-3dSourcecontrol:Fluidtherapy:colloids=crystalloids,VLTVasopressors:AfterVLS,NEvsDopa,Low-dosedopaisnot,cathforvasoInotropictherapy:lowCO-dobu,highCOisnotSteroid:lowdoserhAPC:APACHEII>25,sepsis-inducedARDS/MOFandnobleedingrisk第二阶段/PhaseIIG

6、uidelinesformanagementofseveresepsis/septicshockBloodproductadministration:targetHb7-9g/dl,EPOonlyinrenalfailureMechanicalventilation:Ppla<30,Hypercapnia,optimalPEEP,PronepositionSedation,analgesiaandNBMs:ProtocolGlucosecontrol:<150mg%Renalreplacement:B

7、icarbonate:pH<7.15DVT:UH/LMWHStressulcerprophylaxis:H2blocker第二阶段/PhaseIITousethemanagementguidelinesToevalutetheimpactonclinicaloutcomeofseveresepsis第三阶段/PhaseIIIESICMSCCMISFAACCN/ACCP/ACEP/ATS/ANZICS/ESCMID/ERS/SIFGuidelinesfortheManagementofAdultswit

8、hHospital-acquired,Ventilator-associated,andHealthcare-associatedPneumoniaThisofficialstatementAmericanThoracicSociety(ATS)AndInfectiousDiseasesSocietyofAmerica(ISDA)ApprovedbytheATSBoardofDirectors,December2004andtheIDSAGuidelin