急诊抗感染问题及有关指南建议__培训课件.pptVIP

耳蜗毒性 肾毒性 硫酸依替米星的评价 较低毒性的新型氨基糖苷类抗生素； 对于肾功能正常老年人细菌感染治疗安全有效； 目前专业指南推荐针对格兰氏阴性细菌感染，尤其是针对铜绿假单孢菌； 抗菌谱广，与青霉素类抗生素有协同效应； 现有资料说明对呼吸道感染治疗与头孢菌素联合使用疗效不亚于其它品种，且安全； 仍应注意其肾毒性和耳毒性，尤其是老年人，原有肾功能损害者不用。 * Rivers et al conducted a randomized, non-blinded trial of standard therapy vs early, goal-directed therapy (EGT) in patients with SIRS criteria and systolic blood pressure (BP) ?90 mm Hg unresponsive to 20 mL/kg of crystalloids, or a lactate ?4 mmol/L. Two hundred and sixty-three patients met the entry criteria and were randomized to either standard therapy (n=133) or EGT (n=130). Patients were monitored by vital signs, laboratory data, cardiac monitoring, pulse oximetry, urinary catheterization, arterial and central venous catheterization. Standard therapy was administered by protocol with critical care consultation and consisted of measures to maintain a CVP of ?8-12 mm Hg, MAP ?65 mm Hg, and UOP of ?0.5 mL/kg/hr. Patients randomized to EGT received an oximetric central venous catheter (CVC) capable of measuring SVO2 and were treated early in the emergency department according to protocol for at least 6 hours before they were transferred to the first available inpatient bed. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77. * Patients treated with EGT received approximately 1.5 liters of fluids during the first 6 hours (3500 vs 5000 mL). In addition, patients treated with EGT received significantly more RBC transfusions (64.1% vs 18.5%). There were no significant differences in vasopressor support during the first 6 hours; however, the EGT group received significantly more vasopressors after 7 hours than did the standard group. While less than 1% of the standard group was treated with an inotrope, almost 14% of the EGT groups received dobutamine. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 20