常见的脓毒症3.0-2016新定义新治疗.ppt

PICS（持续炎症、免疫抑制和代谢综合征） New syndrome for individuals who survive the initial sepsis event but become chronically critically ill—the “persistent inflammation-immunosuppression and catabolism syndrome” (PICS) .  PICS is defined as ongoing inflammation, manageable organ failure, ongoing protein catabolism, and poor nutrition, leading to cachexia, poor wound healing, and immunosuppression with increased susceptibility to secondary infections. Model of persistent inflammation-immunosuppression and catabolism syndrome (PICS). Role of myeloid-derived suppressor cells (MDSCs) in severe sepsis/septic shock patients. Sepsis, emergency myelopoiesis, MDSC expansion, and the development of CCI and PICS. 小结 The PICS definition is primarily a tool to provide the foundation for rational treatment strategies of this chronic critically ill population. Driven by the continuous exposure to endogenous danger–associated and pathogen-associated products resulting from organ injury, opportunistic infections, and/or viral reactivation, these patients are trapped in a vicious cycle of inflammation, immunosuppression, and protein catabolism. A combination of therapies including anti-inflammatory agents, immune adjuvants, and nutritional and physical support is likely to be required for optimal outcomes.  五、脓毒症的治疗：2016新改变 Sepsis 病因 胰腺炎、组织缺血、创伤和手术组织损伤、烧伤、血栓栓塞、血管炎、药物反应（包括恶性综合征），和自身免疫性疾病和肿瘤的过程，如淋巴瘤、噬血细胞综合征。 肺炎克雷伯菌 绿脓杆菌 鲍曼不动杆菌 链球菌 粪肠球菌 脓毒症和感染性休克治疗进展 脓毒症和感染性休克治疗进展 脓毒症和感染性休克治疗进展 1小时内！ 二、抗感染：一旦发病，立即上！ 脓毒症和感染性休克治疗进展 脓毒症和感染性休克治疗进展 138.Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012.?Crit Care Med2013;41:580-637 脓毒症和感染性休克治疗进展 脓毒症和感染性休克治疗进展 脓毒症和感染性休克治疗进展 脓毒症和感染性休克治疗进展 脓毒症和感染性休克治疗进展 脓毒症和感染性休克治疗进展 未来研究的热点 Model of persistent inflammation-immunosuppression and catabolism syndrome (PICS). Early deathsfrom acute multiple organ failure (MOF) secondary to the acute hyperinflammatory phase of sepsis havedeclined with implementation of best