严重感染治疗策略邱海波.ppt

重症感染的重要性 细菌耐药机制及ICU细菌流行情况 重症感染的治疗策略 －感染灶的充分引流 －早期经验性治疗 －正确的目标性治疗 Sepsis = Infection+SIRS  infection损伤 SIRS sepsis severe sepsis septic shock MODS/ MOF Impact of adequate empirical antibiotic therapy on the outcome of pats admitted to ICU with sepsis Sepsis in worldwide 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 全球Sepsis的发病率和死亡率均很高，耗费大量的人力物力 呼吁全球 医务专业人员和组织、政府、卫生机构甚至公众支持该行动 Improve survival in severe sepsis AIM: 5年内Sepsis死亡率减少25% Develop guidelines Bedside clinician could use to improve outcome in severe sepsis ans septic shock Guidelines for management of severe sepsis/ septic shock Initial resuscitation: early goal-directed therapy Diagnosis: appropriate culture Antibiotic therapy: Early broad-spectrum, reassessed 2-3d Source control: Fluid therapy: colloids=crystalloids,VLT Vasopressors: After VLS, NE vs Dopa, Low-dose dopa is not , cath for vaso Inotropic therapy: low CO-dobu, high CO is not Steroid: low dose rhAPC: APACHE II 25, sepsis-induced ARDS/MOF and no bleeding risk Guidelines for management of severe sepsis/septic shock Blood product administration: target Hb 7-9g/dl, EPO only in renal failure Mechanical ventilation: Ppla30, Hypercapnia, optimal PEEP, Prone position Sedation, analgesia and NBMs: Protocol Glucose control: 150mg% Renal replacement: Bicarbonate: pH 7.15 DVT: UH/LMWH Stress ulcer prophylaxis: H2blocker To use the management guidelines To evalute the impact on clinical outcome of severe sepsis Epidemiology 2nd most common nosocomial infection 5-10 cases/ 1000 admissions 6- to 20-fold higher in those mechanically ventilated 25% of all ICU infections 50% of all antibiotics prescribed for this