血液及其相关制剂在特护病房、重病房的应用课件.pptVIP

SY Huang 血液及其相关制剂在特护病房、重病房的应用 台大医院 黄圣懿 医师 大纲说明 药 病生 理机转 临床应用 实证效果 Single organ failure Severe sepsis Complication Severe Sepsis: New Concepts in Pathogenesis and Management Cytotoxic effects of microorganisms Endothelial injury response Coagulation thrombosis Inflammation Drotrecogin Alfa Activated XigrisR Recombinant human activated protein C Mechanisms MTD Adverse effects Clinical trials Pharmacoecnomics Drotrecogin Alfa Activated : Mechanisms Recombinant Human Activated Protein C rhAPC High risk of death APACHE II 25 Sepsis-induced multiple organ failure Septic shock Sepsis induced ARDS No absolute contraindications Weigh relative contraindications Grade B Bleeding complications: 3.5% vs. 2.0% Formation of alloreactive antibody Heparin Effect in Drotrecogin alfa activated Treatment Blood Products Blood Products AdministrationRed Blood Cells Tissue hypoperfusion resolved No extenuating circumstances Coronary artery disease Acute hemorrhage Lactic acidosis Transfuse 7.0 g/dl to maintain 7.0-9.0 g/dL ↑DO2 but not VO2; ↑PVR SVR Grade B Conditions in Septic Patients that May Require a Higher Hemoglobin Acute instability Cardiovascular disease coronary artery disease low cardiac output Pulmonary disease severe arterial hypoxemia Organ or tissue ischemia severe mixed venous desaturation elevated lactate level Platelet administration Transfuse for ≤ 5000/mm3 prophylaxis Transfuse for 5000/mm3 30,000/mm3 with significant bleeding risk Transfuse 50,000/mm3 for invasive procedures or bleeding Grade E 血色素低到多少要输血? 先看症状再看数值, 治疗病人而非血色素 一般内科病人 7 gm/dl 一般外科病人 7~10 gm/dl Acute coronary syndrome 10 gm/dl 化疗及放射线治疗 10 gm/dl 血小板低到多少要输血? 治疗性, 视出血状况而定 预防性 感染发热 20,000/ul 非感染发热 15,000 - 5000/ul Massive transfusion ITP TTP 不可直接输血小板 凝血时间长到多少要输血? 治疗性输血PT 17.5 seconds 预防性输血PT 17.5 seconds 肝病合并多凝血因子缺乏 血栓性血小板低下症 什么时候可以输白血球? ANC 500/ul 合并严重感染 骨髓有恢复机会 血液干细胞移植 白血球功能低下 有弥漫性血管内凝血者 DIC ? 去除根本致病因 sepsis, tumor, injury