EGDT应用流程ppt课件.pptVIP

EGDT应用流程 EGDT Early goal-directed therapy in the treatment of severe sepsis and septic shock. Rivers E N Engl J Med. 2001 Nov 8;345(19):1368-77. Early goal-directed therapy in the treatment of severe sepsis and septic shock.Rivers E N Engl J Med. 2001 Nov 8;345(19):1368-77. Early goal-directed therapy in the treatment of severe sepsis and septic shock.Rivers E N Engl J Med. 2001 Nov 8;345(19):1368-77. EGDT Early goal-directed therapy in the treatment of severe sepsis and septic shock. Rivers E N Engl J Med. 2001 Nov 8;345(19):1368-77. In-hospital mortality was 30.5 percent in the group assigned to early goal-directed therapy,as compared with 46.5 percent in the group assigned to standard therapy (P = 0.009). During the interval from 7 to 72 hours, the patients assigned to early goal-directed therapy had a significantly higher mean (+/-SD) central venous oxygen saturation (70.4+/-10.7 percent vs. 65.3+/-11.4 percent), a lower lactate concentration (3.0+/-4.4 vs. 3.9+/-4.4 mmol per liter), a lower base deficit (2.0+/-6.6 vs. 5.1+/-6.7 mmol per liter), and a higher pH (7.40+/-0.12 vs. 7.36+/-0.12) than the patients assigned to standard therapy (P or = 0.02 for all comparisons). EGDT 早期目标导向性治疗（Early goal-directed therapy ） 来源：2001年Rivers的临床随机对照实验研究 临床随机对照单盲实验、单中心、样本量小。 2004年写入严重感染和感染性休克治疗指南 其概念： 有明确的目标——提高心输出量和组织氧供为 治疗目标的治疗。 有明确的时限——早期6小时内。 EGDT 早期复苏目标： CVP ：8—12mmHg 平均动脉压≥65mmHg 尿量≥0.5mL/ ( kg·h) 中心静脉或混合静脉血氧饱和度≥70 % EGDT 实现目标的步骤： 1 液体疗法 即在30分钟内，给予500—1000ml 的晶体液或300—500ml的胶体液 ，同时观察病人的反应性（血压/尿量）和对补液的耐受性（血管内容量负荷）来决定是否再次进行快速补液。补液量至少20—30ml/kg。 EGDT 实现目标的步骤： 2 如果通过补液使得CVP 达到8—12mmHg 而平均动脉压仍然低于65mmHg 可应用血管活性药物使平均动脉压≥65mmHg 首选的血管活性药物： 去甲肾上腺素