脓毒症HAT疗法PPT课件.ppt

脓毒症的HAT疗法 西部战区总医院干部ICU 1 CHEST 2017; 151(6):1229-1238 Baseline Characteristics of Treated and Control Patients Paul E. Marik 2 ICU Treatment Protocol Outcome and Treatment Variables Treated 1.Vitamin C 1.5 g, q6h for 4 days or until ICU discharge; (30~60min infusion) 2.Hydrocortisone 50 mg, q6h for 7 days or until ICU discharge followed by a taper over 3 days; 3.Thiamine 200 mg,q12h for 4 days or until ICU discharge (30-min infusion) Control Hydrocortisone 50 mg, q6h for 7 days or until ICU discharge followed by a taper over 3 days; 3 结论： 早期静脉注射维生素C，配合使用皮质类固醇和硫胺素可有效预防进行性器官功能障碍，降低严重脓毒症和脓毒症休克患者的死亡率，需要进一步的研究来证实这些初步结果。 4 The Changing Paradigm of Sepsis: Early Diagnosis, Early Antibiotics, Early Pressors,and Early Adjuvant Treatment Critical Care Medicine.2018 Vitamin C for the treatment of Sepsis: The Scientific Rationale Pharmacology therapeutics.2018 Adjuvant Vitamin C in critically ill patients undergoing renal replacement therapy: What’s the right dose? Critical Care.2018 Hydrocortisone, Ascorbic Acid and Thiamine (HAT Therapy) for the Treatment of Sepsis. Focus on Ascorbic Acid Nutrients.2018 Patterns of Death in Patients with Sepsis and the Use of Hydrocortisone, Ascorbic Acid, and Thiamine to Prevent these Deaths Surgical Infections.2018 5 Hydrocortisone, Ascorbic Acid and Thiamine (HAT Therapy) for the Treatment of Sepsis. Focus on Ascorbic Acid HAT therapy Hydrocortisone Ascorbic Acid Thiamine Nutrients 2018, 10, 1762-75 6 HAT attenuates both the pro- andanti-inflammatory Nutrients 2018, 10, 1762-75 HAT therapy 7 Paradigm change in the management of sepsis and septic shock Critical Care Medicine.2018 HAT therapy 8 争议质疑 Vitamin C Is Not Ready for Prime Time in Sepsis but a Solution Is Close Chest.2017.676 研究设计问题，非盲法、随机对照、病例数少（47），基线不一致性 Vitamin C in Sepsis When It Seems Too Sweet, It Might (Literally) Be Chest.2017.450 POC监测结果误差较大，存在低血糖风险 Hydrocortisone, Vitamin C and Thiamine fo