重型颅脑损伤救治指南技巧.pptVIP

在重型颅脑损伤最初24小时以及ICP不增高状况下，不采用过度通气疗法。 ICP增高，采用脱水、CSF外引流、应用镇静药、肌松剂等方法无效时，短暂的过度换气可能有益。 长时程过度通气疗法，并不能改善病人预后，还可能增加病人死亡率。 甘露醇对控制ICP增高有效，有效剂量为0.25-1.Og／kg，间断给药，可配合应用速尿。 应补充适量液体，维持正常血容量，留置导尿管。 甘露醇在给药15—30分钟后发生渗透脱水作用，可持续至4小时。大剂量应用切勿使血浆渗透压超过320mOsm／L，若超此限，有并发急性肾功能衰竭(急性肾小管坏死)的危险。 在改善ICP增高及CPP上，甘露醇优于巴比妥。 8.巴比妥用于控制颅内压增高 巴比妥降低ICP，提高重型颅脑损伤病人生存率。作用机制为：①改变血管张力，调节脑血流；②降低代谢率；③抑制自由基介导的脂质过氧化作用。用药中要监测血浆中巴比妥浓度。 巴比妥应用的原则：①其他治疗皆失效；②必须在循环系统稳定时才能应用。 巴比妥治疗药物血浆浓度为3-4mg／100ml。 并发症最主要是引起低血压。 引注Eisenberg临床试验用药方案： 开始剂量10mg／(kg·30min)或5mg／(kg·h)，x 3次，维持剂量lmg／(kg·h)。 Many people do not understand that ethics are situation-specific and time-based -- and business ethics are no exception. Teaching Tip: But this does not mean that ethics are capricious or unimportant. In fact, all societies have a code of ethics and more businesses than ever recognize that a strong code of ethics is good business: it can protect the company from internal wrong-doing and possible legal liability, and, for marketers, serve as a strong foundation upon which to build long-term customer relationships. Ethical development can be thought of as having three levels: Preconventional Morality. This childlike level is calculating and self-centered. As a selfish morality, it is typically based upon what is likely to be immediately rewarded or punished. Conventional Morality. At this level the focus moves away from the self and toward the expectations (conventions) of the society in which the individual lives. Loyalty and obedience to “the rules” are important and this behavior can be generalized from society as a whole to an attachment to one’s company or organization. Marketers at this level are concerned with whether or not an activity is legal and how it is viewed by others. Postconventional Morality. At this level, the individual takes a long-run view of her or his actions, weighing them in relation to terminal values and matters of principle. This is the morality of the ma