血液及其相关制剂在特护病房重病房的应用.pptVIP

SY Huang 血液及其相关制剂在特护病房、重病房的应用 台大医院 黄圣懿 医师 大纲说明 药(病生)理机转 临床应用 实证效果 Single organ failure Severe sepsis Complication Severe Sepsis: New Concepts in Pathogenesis and Management Cytotoxic effects of microorganisms Endothelial injury response Coagulation (thrombosis) Inflammation Drotrecogin Alfa (Activated) XigrisR Recombinant human activated protein C Mechanisms MTD Adverse effects Clinical trials Pharmacoecnomics Drotrecogin Alfa (Activated): Mechanisms Recombinant Human Activated Protein C (rhAPC) High risk of death APACHE II 25 Sepsis-induced multiple organ failure Septic shock Sepsis induced ARDS No absolute contraindications Weigh relative contraindications Grade B Bleeding complications: 3.5% vs. 2.0% Formation of alloreactive antibody Heparin Effect in Drotrecogin alfa (activated) Treatment Blood Products Blood Products AdministrationRed Blood Cells Tissue hypoperfusion resolved No extenuating circumstances Coronary artery disease Acute hemorrhage Lactic acidosis Transfuse 7.0 g/dl to maintain 7.0-9.0 g/dL ↑DO2 but not VO2; ↑PVR SVR Grade B Conditions in Septic Patients that May Require a Higher Hemoglobin Acute instability Cardiovascular disease coronary artery disease low cardiac output Pulmonary disease severe arterial hypoxemia Organ or tissue ischemia severe mixed venous desaturation elevated lactate level Platelet administration Transfuse for ≤ 5000/mm3 (prophylaxis) Transfuse for 5000/mm3 30,000/mm3 with significant bleeding risk Transfuse 50,000/mm3 for invasive procedures or bleeding Grade E 血色素低到多少要输血? 先看症状再看数值, 治疗病人而非血色素 一般内科病人 7 gm/dl 一般外科病人 7~10 gm/dl Acute coronary syndrome 10 gm/dl 化疗及放射线治疗 10 gm/dl 血小板低到多少要输