感染性休克co存在低正常和高3种情况ppt课件.pptVIP

严重感染和感染性休克治疗进展;Annual incidence of severe sepsis: 3 cases/ 1,000 Kill: 1,400 people worldwide /d 25 people /h Moreover, No. of sepsis pats is projected to increase by 1.5% per annum 严重感染的病死人数超过乳腺癌、直肠癌、结肠癌、胰腺癌和前列腺癌的总和 严重感染 vs AMI:发病率相同，病死率明显高;Surviving Sepsis Compaign拯救Sepsis运动;Surviving Sepsis Campaign;GUIDELINES FOR MANAGEMENGT OF SEVERE SEPSIS AND SEPTIC SHOCK;循证医学----推荐级别;A-Initial resuscitation: early goal-directed therapy B-Diagnosis: appropriate culture C-Antibiotic therapy: Early broad-spectrum, reassessed 2-3d D-Source control: E-Fluid therapy: colloids=crystalloids,VLT F-Vasopressors: After VLS, NE vs Dopa, Low-dose dopa is not , cath for vaso G-Inotropic therapy: low CO-dobu, high CO is not H-Steroid: low dose I-rhAPC: APACHE II 25, sepsis-induced ARDS/MOF and no bleeding risk;J-Blood product administration: target Hb 7-9g/dl, EPO only in renal failure K-Mechanical ventilation: Ppla30, Hypercapnia, optimal PEEP, Prone position L-Sedation, analgesia and NBMs: Protocol M-Glucose control: 150mg% N-Renal replacement: O-Bicarbonate: pH 7.15 P-DVT: UH/LMWH Q-Stress ulcer prophylaxis: H2blocker R-Consideration of limitation of support;A. 早期复苏;A. 早期复苏;B. 病源学诊断;Peripheral blood(PB) ;*p 0.001;B. 病源学诊断;C. 抗生素治疗;High mortality of sepsis, severe sepsis and septic shock;C. 抗生素治疗;D. 治疗原发病灶;D.治疗原发病灶;;Modifiable Risk Factors;Modifiable Risk Factors;E. 液体治疗;E. 液体治疗;F. 血管活性药物;F. 血管活性药物;NE和Dopa优于肾上腺素和苯肾上腺素 Dopa通过提高SV和HR来提高动脉BP和CI NE通过缩血管效应来提高BP，不改变SV和HR NE改善低血压状态更有效，Dopa改善心肌收缩力更有效，但易致心律失常;A large randomized trial and a meta-analysis Low-dose dopamine and placebo No difference in Peak serum Cr, need for RRT,Urine output, timeto recovery of normal renal function Survival, ICU stay, Hospital stay, Arrhythmias;G.正性肌力药物;G.正性肌力药物;H. 糖皮质激素;肾上腺功能低下的感染性休克低剂量的糖皮质激素可逆转休克、降低病死率;;Mortality rate;H. 糖皮质激素;H. 糖皮质激素;I. 重组人活化蛋白C (rhAPC);J. 血液制品;Transfusion requirements in critical care;J. 血液???品;Efficacy of rHuEPO;J. 血液制品;K. ALI/ARDS的机械通气;小潮气量通气研究;结果分析;K. ALI/ARDS的机械通气;K.