脓毒症导致医疗系统的巨额费用课件.pptVIP

* * * ....and economic problem Sepsis is a disease causing high costs for the health care systems和经济问题：脓毒症导致医疗系统的巨额费用 USA: Costs per year: 16.7 billion US$ p.a. (++ adults 65 years) Costs per case: 22.100 US$ 美国： 每年１６７亿美元 ２２１００美元每例病人 Germany: Costs per year: 5.3 billion € p.a., or 19 to 42% of the ICU budgets Costs per case: 20.000 € Length of stay in ICU: 18 days (vs 5 days in pts without sepsis) Costs per day: 1650 €/day (death) / 1160 € (survived) Angus et al., Crit. Care Med. 2001; Moerer et al., Int. Care Med. 2002; Schmid et al., Wien. Klin. Wochenschr., 2002 Diagnosis of Sepsis脓毒症的诊断 Sepsis should be diagnosed early, since early treatment is most effective A focus of infection has to be detected early, to eliminate it properly (antibiotic treatment, surgery) The progression of the disease and complication by organ dysfunction should be monitored, since organ dysfunction during sepsis has a high mortality rate The course of systemic inflammation should be monitored, to evaluate success of treatment or uneffectiveness of therapeutic measures Why is early diagnosis of sepsis so important?为何脓毒症的早期诊断十分重要 死亡率随着疾病的进展而增加Mortality rates grow with progression of disease Rangel-Frausto et al, JAMA 1995 器官衰竭数目 Number of organ failures: 0 to 1 ? ~15%2 ? 33 to 50%3 or more ? 70% Angus, Crit.Care Med. 2001 Moerer et al., Int.Care Med. 2002 疾病严重程度 Severity of disease SIRS Sepsis SevereSepsis Septic Shock 死亡率 Mortality rate 脓毒症确诊及治疗介入的越晚，患者死亡率越高Mortality rates grow the later sepsis is diagnosed and therapeutic intervention is started 早期入住ICU能提高生存率 Early ICU admission improves survival chance: 死亡率Mortality rate 出现脓毒症之后入住ICU ICU admission after onset of sepsis ? 47.5% 出现脓毒症之前入住ICU ICU admission before onset of sepsis ? 37.4% 早期介入治疗能提高生存率 Early therapeutic intervention increases survival chance 死亡率Mortality rate 儿茶酚胺使用1小时以上 1h before catecholamine use ? 70% 儿茶酚胺使用1小时以内 1h before catech