ICU的发热问题课件.ppt

怎么理解发热？ ? 发热的定义取决于定义它的目的。 ? 核心温度 38 ℃。 ? 两次连续的体温 38.3 ℃。 ? 对于粒细胞减少的病人，发热则指不受外界环 境影响时单次口腔温度 38.3 ℃，或者 38.0 ℃并 且时间超过 1 小时。 ? 各种各样发热的定义是可以接受的。 Crit Care Med 2008 Vol. 36, No. 4 ? infections are rarely if ever associated with core temperatures over 41.1 ° C 。 ? When the core temperature is this high, the clinician should suspect malignant hyperthermia , neuroleptic malignant syndrome , or heat stroke 发热患者的初始处理 ? the overview of the medical record; ? the physical examination; ? the evaluation of characteristics of the fever magnitude, duration, relationship to patients pulse rate, temporal relationship to diagnostic and therapeutic interventions 。 在初始处理前，你还要。。。 the initial evaluation should be focused on ruling out septic syndrome development originated by urinary tract infection, VAP/nosocomial pneumonia, phlebitis, wound infections, or bacteremia. ? unexplained or unknown origin fever ? unexplained leukocytosis, anion gap acidosis, hypotension or persistent tachycardia and tachypnea Gozzoli V, Treggiari MM, Kleger GR, et al. Randomized trial of the effect of antipyretics by metamizol, propacetamol or external cooling on metabolism, hemodynamics and inflammatory response. Intensive Care Med 2004;30(3):401 – 7 ? Antipyretic agents are agents able to block or reverse the cytokine-mediated rise in core temperature caused by fever without affecting body temperature and must be distinguished from hypothermic agents that are able to lower core temperature even in the absence of fever Mackowiak PA. Physiological rationale for suppression of fever. Clin Infect Dis 2000;31(Suppl 5):S185 – 9. ? The external cooling methods---hypothermia blankets ? side effects including ? the large temperature fluctuations , ? the development of rebound hyperthermia, ? the appearance of hypermetabolism , ? increased oxygen consumption, ? leading to elevated lev