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1、2012全身性感染与感染性休克全身性感染(sepsis):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:
2、Analysisofincidence,outcomeandassociatedcostsofcare.SurvivingSepsisCampaign(SSC)GuidelinesforManagementofSevereSepsisandSepticShockDellingerRP,CarletJM,MasurH,GerlachH,CalandraT,CohenJ,Gea-BanaclocheJ,KehD,MarshallJC,ParkerMM,RamsayG,ZimmermanJL,VincentJL,Le
3、vyMMandtheSSCManagementGuidelinesCommitteeCritCareMed2004;32:858-873IntensiveCareMed2004;30:536-555availableonlineatspringerlinksccm.orgsepsisforumTheguidelineswerepublishedinbothCriticalCareMedicineandinIntensivecareMedicine,andareavailableon-lineSurvivingS
4、epsisCampaignGuideline最初复苏(initialresuscitation)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(me
5、chanicalventilationofsepsis-inducedALI/ARDS)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(considerationforlimitationofsupport)SurvivingSep
6、sisCampaignGuideline最初复苏(initialresuscitation)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(mech
7、anicalventilationofsepsis-inducedALI/ARDS)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(considerationforlimitationofsupport)严重全身性感染与感染性休克的
8、治疗SIRSSepsisSevereSepsisSepticShock血糖控制非常重要:最初病情稳定后静脉输注胰岛素1B目标范围?血糖<150mg/dL2C血糖控制方案2C葡萄糖热卡及监测1B强化胰岛素治疗严格控制血糖外科患者的强化胰岛素治疗随机分组对照组强化胰岛素组开始输注胰岛素时的葡萄糖水平>215mg/dL>110mg/dL胰岛素治疗维持葡萄糖水平180–200mg/dL(10.
