重症感染的的知识点.ppt

重症感染的知识点 s5-6n SEPSIS的病理生理进程 INFECTION SIRS sepsis sepsis MODS Septic shock 感染的认识 、有无感染? 感染的部位? 3、致病微生物? 4、敏感抗生素以及非药物治疗措施 5、抗感染治疗疗程和支持治疗 6、什么时间停止药物治疗 重症感染 威胁生命的感染。 由致病生物在机体内生长繁殖,引起某一脏 器或全身感染且因感染而致该脏器或全身 多脏器功能衰竭或衰竭的感染 国际上重症感染的治疗的意见 加强对患者的观察和监测 ·综合使用实验室检査和临床经验,及早发现/疑似患者。 ·力争在发病后6h内明确诊断,并立即开展EGDT 措施:强力有效的抗感染、监测循环障碍和预防组织缺氧等 ·目标是消除致病菌、纠正循环障碍及组织缺氧状态、阻断疾 病发展的炎症级联反应恶性循环的目的。 重症感染的早期诊断 临床表现 乳酸 ·微循环监测 一般的实验室检查 生物标志物(PCT、CRP、TREM-1) 重症感染的临床表现早期诊断的价值 CHEST Postgraduate education Corner Early Goal-Directed Therapy in Severe Sepsis and septic Shock Revisited 在3102例可能存在感染的患者中,SIRS的 依据SRs的表现并不能早期诊断重症感染 24%感染性休克的患者符合SIRS的诊断标准 duplicate the pr叼 些装品盖 Tinwakngi rtery sheean scan, awn rutiEmnsNia,-wuiteel weilie 重症感染的临床表现早期诊断的价值 依据SRS的表现并不能早期诊断重症感染。 器官功能损伤的数量可以用于重症感染患者病情的 评价82% 重症患者评价系统都有助于评价患者的严重程度和 预后一—SOFA评分 ·临床表现+辅助检査是不错的选择。 乳酸有助于重症感染的早期识别 Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock e Mark E Mikkelsen, MD, MS; Andrea N. Miltiades, BA; David F. Gaieski, MD: Munish Goyal, MD m乳酸的升高有助于早期识别重症感染的pm 发生,并且提示重症感染患者的不良预后 Desigr Single-center cohort study. The primary outcome was potential confounders, intermediate and high serum lactate levels 28-day mortality and the risk factor variable was initial venous remained significantly associated with mortality within shock and lactate(mmol/Lh, categorized as low(2), intermediate (2-3.9), nonshock strata. or high 64. Potential covariates included age, sex, race, acute Camelus aon: Initial serum lactate was associated with mor tality independent of early goal-directed therapy. Multivariable shock in patients nalyses were stratified on the presence intermediate and hi indepen dently Sering: The ED of an academic teri Care Me 3:1670-167 KEY WORDs: severe sepsis; lactic acid; infection; hy potens on; Patients: Eight hundred thirty adults admitted with severe mortality sepsis in the ED. Crit Care med 2009 Vol 37. No 5