感染性休克早期目标治疗策略更新-培训课件.ppt

PH PCO2 mmHg PO2 mmHg HCO3-mmol/L BE mmol/L SaO2 % 血压mmHg 乳酸 mmol/L 3-7 6.96 11 114 ＜3 未测出 3-8 7.18 18 168 6.7 -19.7 99 7.7 3-8 7.35 30 199 16.6 -9.0 100 3.9 3-9 7.37 31 79 17.9 -6.6 95 126/84 3.0 3-10 7.41 31 92 19.6 -4.4 97 1.6 血气、乳酸变化趋势表 PH PCO2 mmHg PO2 mmHg HCO3-mmol/L BE mmol/L SaO2 % 乳酸 mmol/L 3-7 6.96 11 114 ＜3 未测出 3-8 7.18 18 168 6.7 -19.7 99 7.7 3-8 7.35 30 199 16.6 -9.0 100 3.9 3-9 7.37 31 79 17.9 -6.6 95 3.0 3-10 7.41 31 92 19.6 -4.4 97 1.6 血气、乳酸变化趋势表 抗感染 碳氢霉烯（抗阴性菌） 头孢硫脒（抗阳性菌） 病 历  体温变化表 加强脏器功能保护 乌司他丁 黄芪 血浆 病 历  03-07-2010 03-07-2010 03-08-2010 感染源？ 病 历  粪便常规：潜血（-）；白细胞1-2/HP 血培养、便培养：（-） 病 历 1 感染源？ 盆腔感染？！ 尿量增多，一般情况好转 体温、生化检查逐步好转 转科 病 历 治疗效果 解放军兰州军区乌鲁木齐总医院 急救中心 重症医学科 It is important to understand that one can acquire four SIRS criteria from running up a flight of stairs. In fact, many insults including trauma, pancreatitis, or thermal injury will produce similar physiologic responses. A sepsis physiology can only be defined in context of a suspected in infection juxtaposed on at least 2 SIRS criteria. Understand that our ability to accurately detect infection is far from optimal, however there remains a significant proportion of patients who exhibit two to four SIRs criteria including progression to severe sepsis and septic shock appearing states. In efforts to further define these patients and their natural history, Rangel-Frausto identified several significant deifferences between culture positive and culture negative patients. These differences primarily included a higher incidence of trauma, cardiovascular disease, GI and repiratory disease in culture negative patients versus culture positive patients. SIRS has many causes; infection can exist without SIRS; when infection and SIRS meet, sepsis exists…sepsis can be mild, severe, or accompanied by shock. Specifically, the term systemic inflammatory response syndrome (SIRS) was developed to imply a clinical response arising from a nonspecific insult Un