抗生素合理使用北京协和医院精要.ppt

* Severe sepsis is sepsis plus signs and symptoms of acute organ dysfunction, hypoperfusion, or hypotension. Hypoperfusion and perfusion abnormalities may include, but are not limited to, lactic acidosis, oliguria, or an acute alteration in mental status. As shown on the next slide, organ dysfunction may involve any of the following alone or in combination: Cardiovascular system Kidney Respiratory system Liver Hematologic (blood, coagulation) Central nervous system Presence of an otherwise unexplained metabolic acidosis Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest. 1992;101:1644-55. * Following identification of a patient with sepsis, the clinician must assess the patient for the presence of acute organ dysfunction (severe sepsis). The presence of acute organ dysfunction is often recognized clinically by the patient’s presenting signs and symptoms. However, in some instances laboratory data or results of invasive monitoring will confirm the diagnosis of organ dysfunction. The illustration of the patient on this slide has arrows pointing to various organs that might provide clues to the presence of organ dysfunction. Indications of organ dysfunction include: Central nervous system: altered consciousness, confusion, psychosis, delirium Respiratory system: tachypnea, hypoxemia, oxygen saturation 90%, decreased ratio of arterial oxygen vs inspired oxygen Liver: jaundice, increased liver enzymes, hypoalbuminemia, increased prothrombin time Cardiovascular: tachycardia, hypotension, increased central venous pressure, increased pulmonary artery occlusive pressure Kidney: oliguria, anuria, increased creatinine Hematological: thrombocytopenia, abnormal coagulation tests, decreased levels of Protein C, increased D-dimers * Standard care of the patient with severe sepsis consists of a number of medical (and sometimes surgical) interventions intended to normalize physiology and el