脓毒性休克治疗.ppt

★ 脓毒症,脓毒性休克的治疗 首都医科大学急诊医学系 北京朝阳医院急诊科 李春盛 ★ Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  一般治疗 体位:头胸部及双下肢均抬高30度 利于膈肌运动及回心血量 ●吸氧:氧流量2-4L/min Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  ●低血压和乳酸酸中毒=低灌注 ●血压正常乳酸升高=低灌注 6小时治疗目标: cVP≥8-12mHg MBP≥65mmHg 尿量≥0.5mg/kg/h SvO2≥70%(B级) Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  ●如补液后 cvP≥8-12mmHg sv0265% 则应输悬浮红细胞,HCT≥30% 多巴酚丁胺(20μg/kg/min)(B级) Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  ● River报道: n输液红细胞升压药死亡率 常规组2633.5L 46.3% 目标治疗组2635L+ 30.5% Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  具体方法:每30min输500m晶体液使 cVP≥8-12mHg 扩血管药使得90mmHg≤MBP≤65mmHg 升压药 HT≥30% CVP Sa0270% 加用多巴酚丁胺2.5g/kg/mn每30min加 2.5μg/kg/mn Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  观察指标 ●6h:T,P,尿量,BP,VP 12-72h:ABG,静脉血气(VP血气),乳 酸,凝血指标 ●临床指标: APACHE|, MASHALL评分等 Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  液体复苏 ●相对、绝对容量不足原因:丢失,出汗, 腹泻,内在丢失水肿,腹膜炎,分布异 常:静脉淤血或动脉扩张等 目的:保存血管内液体容量,恢复有效组 织灌注,重建和维持组织氧供需平衡 Evaluauon onr. ch Asposeslides for NET 4o dient P Evaluation only. Created with Aspose Slides for NET 4.0 dient Profilo 71 Copyright 2004-2017Aspose Pty L  最佳液体复苏 ●白蛋白,红细胞? 液体复苏终点? ●晶体液,胶体液? Evaluauon onr. ch Asp