脓毒血症的抗生素治疗.pptxVIP

脓毒血症的抗生素治疗

SeveresepsisandsepticshockiscommoninHosp9%ofhospitaladmissions10%ofadmissionsintoICUMortality30%

SSC脓毒症及感染性休克治疗指南(2008)A．液体复苏B．细菌学诊断C．抗生素治疗D，感染源的控制E．液体治疗F．血管加压剂G．正性心肌力药物治疗H．激素I．重组人体活化蛋白C（rhAPC）

J．血液制品的使用K．机械通气L．镇静、麻醉及神经肌肉阻滞剂M．血糖控制N．肾替代治疗O．碳酸氢盐治疗P．预防深静脉血栓Q．预防应激性溃疡

01Sepsisresuscitationbundle03Within6h05managementgoals02(7)tasks04Sepsismanagementbundle06Within24hSepsisBundle

Sepsisresuscitationbundle1.测定血浆乳酸水平2.在使用抗生素之前先进行血培养3.在进入急诊室的3小时内和ICU的1小时内给予广谱抗生素4.患者存在低血压和/或乳酸水平4mmol/L(EGDT)a,给予一个首次20ml/kg的晶体(或胶体液)b.对最初的液体复苏无效的低血压可给予血管收缩剂，使其平均动脉压维持在=65mmHg5.尽管进行了液体复苏，但患者仍存在持续的低血压和/或乳酸4mmol/La.应维持CVP=8mmHgb.应使ScvO2=70%(OR65%)

Sepsismanagementbundle1.对于感染性休克患者，给予小剂量的皮质醇2.给予重组活化蛋白C3.控制血糖水平，应低于150mg/dl(8.3mmol/L)4.机械通气时，送气平台压30cmH2O

Sepsis病人的高死亡率%MortalityActivatedCproteinBernardGRetal.NEnglJ.Med2001;344:699-709.31%25%01020304050607031%25%-6%AdequateATBtherapyVallesJetal.Chest2003;123:1615-1624.63%31%-32%WithoutHydrocortisoneAnnaneetal.JAMA2002;288:862-87163%53%63%53%-10%WithEarlygoal47%30%-17%RiversEetal.NEJM2001;345:1368-73

感染性休克常发生在Sepsis后24h内EstenssoroE,GonzalezF,LaffaireE,CanalesH,SaenzG,ReinaR,etal.ShockonadmissiondayisthebestpredictorofprolongedmechanicalventilationintheICU.Chest2005;127:598-603.When:Transitionfromsepsistoshock??Mostoftenduringthefirst24hrsofhospitalization1PMV:prolongedMV(MV21d)2

GoldenHourandSilverDayBlowO,etal.GoldenHourandtheSilverDay:

DetectionandCorrectionofOccultHypoperfusionwithin24HrsImprovesOutcomefromMajorTrauma.JTrauma,1999,47:964DetectionandCorrectionofOccultHypoperfusionwithin24HrsImprovesOutcomefromMajorTraumainEDsMorbidityandsurvivalversustimetocorrectocculthypoperfusion.Filledbars,survivalHatchedbars,RespitcomplicationDottedbars,MSOF.

Effectiveantimicrobialtherapyatfirst6hCritCareMed2006;3