1感染性休克的治疗进展分析.pptVIP

感染性休克的治疗进展; SIRS;易感染部位;SIRS;Sepsis ;Mortality;严重败血症发生率与死亡率随年龄增加;确认严重败血症时发生的器官功能障碍;感染;Excessive inflammatory mediator production during sepsis;The Surviving Sepsis Campaign was initiated in 2002 by the European Society of Intensive Care Medicine, the International Sepsis Forum, and the Society of Critical Care Medicine with the intent to reduce mortality rates in severe sepsis by 25% in 5 years. ;Initial Resuscitation Diagnosis Antibiotic therapy Source Control Fluid therapy Vasopressors Inotropic Therapy Steroids Recombinant Human Activated Protein C (rhAPC) [drotrecogin alfa (activated)];Sackett DL. Chest 1989; 95:2S–4S Sprung CL, Bernard GR, Dellinger RP. Intensive Care Medicine 2001; 27(Suppl):S1-S2;EGDT复苏最初6小时目标（1C）;初始6小时的复苏捆绑工作;Rivers E et al. N Engl J Med 2001;345:1368-1377;The Importance of Early Goal-DirectedTherapy for Sepsis Induced Hypoperfusion ;目标导向疗法 – 执行结果;Sepsis捆绑处理 Management Bundle;严重Sepsis的现代治疗Current Treatment of Severe Sepsis;抗菌疗法;血流动力学处理;液体复苏;液体复苏;液体复苏:碳酸氢钠;Changing pH Has Limited Value;液体复苏: 输血;血液制品;血液制品;Transfusion Strategyin the Critically Ill;血管升压类药物;血管加压类药物疗法: 目标;多巴胺;去甲肾上腺素;去甲肾上腺素;肾上腺素;新福林 ;加压素;多巴酚丁胺;辅助通气;% Mortality;糖皮质激素Glucocorticoids;控制血糖(1B);治疗终点;重组人活化蛋白CRecombinant Human Activated protein C rhAPC;推荐用于由于 severe sepsis，危及生命的MODS、 septic shock或 其引起的 ARDS，（大多数APACHE II ≥ 25 ）的成年患者。它有增加出血的可能，而且价格昂贵。 推荐低死亡危险严重脓毒症成年患者（大多数APACHE II ＜ 20 或一个器官衰竭），不接受rhAPC。（1A）;Drotrecogin Alfa;Mortality and Numbers of Organs Failing;rhAPC的禁忌症;支持疗法;预防DVT;支持疗法;持续肾替代疗法CRRT与 Sepsis;肾替代疗法;ECMO 在SEPSIS的应用;其他新进展——抗内毒素治疗;其他新进展——抗内毒素治疗;其他新进展——抗炎症介质治疗;其他; 谢 谢 ！