2008严重感染和感染性休克 治疗指南概要

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1、Internationalguidelinesformanagementofseveresepsisandsepticshock:20082008严重感染和感染性休克治疗指南概要MAJORRECOMMENDATIONSThegradesofrecommendations(A-E)andgradesofevidence(I-V)aredefinedattheendofthe"MajorRecommendations"field.A.InitialResuscitation1.Theresuscitationofapatientinseveresepsisorsepsis-

2、inducedtissuehypoperfusion(hypotensionorlacticacidosis)shouldbeginassoonasthesyndromeisrecognizedandshouldnotbedelayedpendingintensivecareunit(ICU)admission.Anelevatedserumlactateconcentrationidentifiestissuehypoperfusioninpatientsatriskwhoarenothypotensive.Duringthefirst6hrsofresuscitat

3、ion,thegoalsofinitialresuscitationofsepsis-inducedhypoperfusionshouldincludeallofthefollowingasonepartofatreatmentprotocol:·Centralvenouspressure:8–12mmHg·Meanarterialpressure>65mmHg·Urineoutput>0.5mL/kg/hr·Centralvenous(superiorvenacava)ormixedvenousoxygensaturation>70%GradeofRecommenda

4、tionB2.Duringthefirst6hrsofresuscitationofseveresepsisorsepticshock,ifcentralvenousoxygensaturationormixedvenousoxygensaturationof70%isnotachievedwithfluidresuscitationtoacentralvenouspressureof8–12mmHg,thentransfusepackedredbloodcellstoachieveahematocritof>30%and/oradministeradobutamine

5、infusion(uptoamaximumof20micrograms/kg/min)toachievethisgoal.GradeofRecommendation:B早期复苏-1(推荐级别:B级) 一旦临床诊断严重感染,应尽快进行积极的液体复苏,6h内达到复苏目标:中心静脉压(CVP)8-12cmH2O平均动脉压≥65mmHg尿量≥0.5ml/kg/h中心静脉或混合静脉血氧饱和度(ScvO2或SvO2)≥0.70早期复苏-2(推荐级别:B级)若开始6h内液体复苏后CVP达8～12cmH2O,而ScvO2或SvO2仍未达到0.70,需输注浓缩红细胞使血细胞比容达到0.3

6、0以上和(或)输注多巴胺(最大剂量至20μg/kg/min)以达到上述复苏目标B.Diagnosis1.Appropriateculturesshouldalwaysbeobtainedbeforeantimicrobialtherapyisinitiated.Tooptimizeidentificationofcausativeorganisms,atleasttwobloodculturesshouldbeobtainedwithatleastonedrawnpercutaneouslyandonedrawnthrougheachvascularaccessdevi

7、ce,unlessthedevicewasrecently(<48hrs)inserted.Culturesofothersitessuchasurine,cerebrospinalfluid,wounds,respiratorysecretions,orotherbodyfluidsshouldbeobtainedbeforeantibiotictherapyisinitiatedastheclinicalsituationdictates.GradeofRecommendation:D2.Diagnosticstudiesshould