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1、严重感染的抗感染策略邱海波东南大学医学院附属中大医院 东南大学急诊与危重病医学研究所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运动巴塞罗那宣言ESICMSCCMISF2002年10月2日,西班牙全球Sep
3、sis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/PhaseIIESICMSCCMISFAACCN/ACCP/ACEP/ATS/ANZICS/ESCMID/ERS/SIFGuidelinesforsepsis.
4、IntensiveCareMed2004,30:536-555Guidelinesformanagementofseveresepsis/septicshockInitialresuscitation:earlygoal-directedtherapyDiagnosis:appropriatecultureAntibiotictherapy:Earlybroad-spectrum,reassessed2-3dSourcecontrol:Fluidtherapy:colloids=crystalloids,VLTVasopressors:AfterVLS,NEvsD
5、opa,Low-dosedopaisnot,cathforvasoInotropictherapy:lowCO-dobu,highCOisnotSteroid:lowdoserhAPC:APACHEII>25,sepsis-inducedARDS/MOFandnobleedingrisk第二阶段/PhaseIIGuidelinesformanagementofseveresepsis/septicshockBloodproductadministration:targetHb7-9g/dl,EPOonlyinrenalfailureMechanicalventil
6、ation:Ppla<30,Hypercapnia,optimalPEEP,PronepositionSedation,analgesiaandNBMs:ProtocolGlucosecontrol:<150mg%Renalreplacement:Bicarbonate:pH<7.15DVT:UH/LMWHStressulcerprophylaxis:H2blocker第二阶段/PhaseIITousethemanagementguidelinesToevalutetheimpactonclinicaloutcomeofseveresepsis第三阶段/Phase
7、IIIESICMSCCMISFAACCN/ACCP/ACEP/ATS/ANZICS/ESCMID/ERS/SIFGuidelinesfortheManagementofAdultswithHospital-acquired,Ventilator-associated,andHealthcare-associatedPneumoniaThisofficialstatementAmericanThoracicSociety(ATS)AndInfectiousDiseasesSocietyofAmerica(ISDA)ApprovedbytheATSBoardofDir
8、ector
