PCT2013秦英智综述.ppt

秦英智 天津呼吸机治疗研究中心 2013,3 济南;To make the diagnosis and thus therapy earlier. To differentiate between infectious and ‘sterile”inflammation. To shorten the time on antimicrobials. To straitify the rist of the pat. To identify distinct phenotypes that may benefit from specific adjunctive sepsis therapies.;Chills 22% Temperature change ＞1.50C 59% Temperature(37.5-38.50C 18% Normothermia 5% Hypothermia 9%;Leukopenia ＜4×109/l 29% Leukopenia ＞12×109/l 57% Normal range 4 ---12×109/l 14%; Reduce Unnecessary Antibiotics!;CRP IL6, IL8… Procalcitonin Protein C Antithrombin Molecular fingerprints Bacterial DNA Endotoxin etc.; Cytokines ( IL-6, IL-10, TNF-α) Rapid increase,Rapid decrese CRP Delay response, Delay secrection ;;;; SIRS with organ dysfunction? Organ dysfunction due to infection ? ;;;Harbarth S. Am J Respir Crit Care Med 2001;;;;; ICU pats with CRP ＞100mg/ml (n=93);;;;;------------;PCT定量检测的临床应用; PCT定量检测的临床应用; 普通感冒 支气管炎 肺炎 VAP/脓毒症 死亡率: 1% 3% 14% 30-50%;;;;Major surgery Severe trauma Haemorrhhagic shock Cardiogenic shock Birth stress Burns Heat shock OKT3,TNF-a,antilymphocyte serum C-cell carcinoma of the thyroid gland and small cell carcinoma of the lung;;;;;To make the diagnosis and thus therapy earlier. To differentiate between infectious and ‘sterile”inflammation. To shorten the time on antimicrobials. To straitify the rist of the pat. To identify distinct phenotypes that may benefit from specific adjunctive sepsis therapies.;We said 8 days Patient is stable Patient has no more fever Patient goes home Patient develop