严重感染感染性休克治疗指南概要.doc

International guidelines for management of severe sepsis and septic shock: 2008 2008严重感染和感染性休克 治疗指南概要 MAJOR RECOMMENDATIONS The grades of recommendations (A-E) and grades of evidence (I-V) are defined at the end of the Major Recommendations field. Initial Resuscitation The resuscitation of a patient in severe sepsis or sepsis-induced tissue hypoperfusion (hypotension or lactic acidosis) should begin as soon as the syndrome is recognized and should not be delayed pending intensive care unit (ICU) admission. An elevated serum lactate concentration identifies tissue hypoperfusion in patients at risk who are not hypotensive. During the first 6 hrs of resuscitation, the goals of initial resuscitation of sepsis-induced hypoperfusion should include all of the following as one part of a treatment protocol: Central venous pressure: 8–12 mm Hg Mean arterial pressure 65 mm Hg Urine output 0.5 mL/kg/hr Central venous (superior vena cava) or mixed venous oxygen saturation 70% Grade of Recommendation B During the first 6 hrs of resuscitation of severe sepsis or septic shock, if central venous oxygen saturation or mixed venous oxygen saturation of 70% is not achieved with fluid resuscitation to a central venous pressure of 8–12 mm Hg, then transfuse packed red blood cells to achieve a hematocrit of 30% and/or administer a dobutamine infusion (up to a maximum of 20 micrograms/kg/min) to achieve this goal. Grade of Recommendation: B 早期复苏-1 (推荐级别:B级)? 一旦临床诊断严重感染,应尽快进行积极的液体复苏,6h内达到复苏目标:中心静脉压(CVP)8-12cmH2O平均动脉压≥65mmHg尿量≥0.5ml/kg/h中心静脉或混合静脉血氧饱和度(ScvO2或SvO2)≥0.70早期复苏-2 (推荐级别:B级)若液体复苏后CVP达8～12cmH2O,而ScvO2或SvO2仍未达到0.70,需输注浓缩红细胞使血细胞比容达到0.30以上和(或)输注多巴胺(最大剂量至20μg/kg/min)以达到上述复苏目标Diagnosis Appropriate cultures should always be obtained before antimicrobial therapy is initiated. To optimize identification of causative organisms, at least two blood cultures should be obtained with at least one drawn percutaneously and one drawn through each vascular access device, unless the device