脓毒症休克治疗指南摘要PPT课件.ppt

2012脓毒症休克治疗指南摘要,1,.,Definitions,Sepsis：isdefinedasthepresenceofinfectiontogetherwithsystemicmanifestationsofinfection.Severesepsis:isdefinedassepsisplussepsis-inducedorgandysfunctionortissuehypoperfusion.Septicshock:isdefinedassepsis-inducedhypotensionpersistingdespiteadequatefluidresuscitation,2,DiagnosticCriteriaforSepsis,1.感染指标变化,2.体征变化,3,DiagnosticCriteriaforSepsis,3.器官功能变化,4.血流动力学改变,5.组织灌注改变,4,SevereSepsis,5,InitialResuscitationandInfectionIssues,6,InitialResuscitationandInfectionIssues,7,6.Wesuggestthatantiviraltherapybeinitiatedasearlyaspossibleinpatientswithseveresepsisorsepticshockofviralorigin(grade2C).(CMV)andherpesvirusesasissignificantpathogensinsepticpatients,especiallythosenoknowntobeseverelyimmunocompromised,remainsunclear.ActiveCMVviremiaiscommon(15%35%)incriticallyillpatients;thepresenceofCMVinthebloodstreamhasbeenrepeatedlyfoundtobeapoorprognosticindicatorAsilentkiller:Cytomegalovirusinfectioninthenonimmunocompromisedcriticallyillpatient.CritCareMed2008;36:32613264,抗病毒药物的使用,8,液体复苏,9,多巴胺VS去甲肾上腺素,多巴胺：升压效果小于去甲；加快心率较易导致恶性心律失常；影响下丘脑垂体激素分泌紊乱；有抑制免疫的作用；小剂量并无改善肾脏供血作用。,去甲肾上腺素：升压效能较大；对心率和心肌收缩力影响较小；对内分泌系统和免疫系统无影响；并降低内脏器官的血供反而可以适当改善血供。,RegnierB,RapinM,GoryG,etal:Haemodynamiceffectsofdopamineinsepticshock.IntensiveCareMed1977;3:4753,PatelGP,GraheJS,SperryM,etal:Efficacyandsafetyofdopamineversusnorepinephrineinthemanagementofsepticshock.Shock2010;33:375380,10,多巴胺VS去甲肾上腺素,多巴胺仅仅推荐应用于有低心律失常风险者和低血压伴有心动过缓者小剂量多巴胺无改善肾脏血流作用（1A）,11,多巴胺VS去甲肾上腺素,AnalysisperformedbyDjillaliAnnaneforSurvivingSepsisCampaignusingfollowingpublications,12,2001PROWESSINseveresepsisshowedasignificantreductioninmortality(24.7%)withrhAPCcomparedwithplacebo(30.8%)。2004SSCrecommendeduseofrhAPCinSevereSepsis（2B）。The2008SSCrecommendationsuseinadultpatientswithaclinicalassessmentofhighriskofdeathAPACHE)IIscores25orMOF(2C）。2011PROWESSSHOCKshowingnobenefitofrhAPCinpatientswithsepticshock(mortality26.4%forrhAPC,