教培用重症感染及感染性休克课件.ppt

1、重症感染及感染性休克文档(3)收缩压90mmHg 或较原基础值下降的幅度40mmHg至少1 小时或血压依赖输液或药物维持;5 mL/kg hr for 2 hrs,despite adequate fluid resuscitation单一测量值意义不大，应连续动态观察渗透压(mmol/L)目标：保证足够的组织灌注。临床上输注1 L 晶体液后,血管内容量可增加100200 ml。感染性休克时应用高张溶液的经验很少。组织缺氧,如血乳酸水平增加、酸中毒等Coagulopathy(INR 1.血乳酸4mmol/L，病死率高达80%。病理性的动脉系统扩张是感染性休克的主要血液动力学特点。常用晶体比较有

2、效血流量不足不仅取决于心输出量,且取决于灌注压力B(中等质量RCT或高质量观察性及队列研究)镇静治疗可以间断镇静，或者持续镇静每日唤醒。低灌注导致的高乳酸患者，PH7.阻力血管扩张导致体循环阻力下降,灌注压力不足以维持组织的血液供应。(2)灌注压过低,导致分布到代谢活跃的组织中的血流不够，仍然不能满足组织代谢的需要。单一测量值意义不大，应连续动态观察Dellinger RP,Levy MM,Carlet JM,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and

3、septic shock:.Crit Care Med ;36(1):296-327.Dellinger RP,Levy MM,Carlet JM,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock:.Crit Care Med ;36(1):296-327.Dellinger RP,Carlet JM,Masur H,et al:Surviving Sepsis Campaign guidelines for management o

4、f severe sepsis and septic shock.Crit Care Med 2004;32:858-873Weil MH,Henning RJ:New concepts in the diagnosis and fluid treatment of circulatory shock.Anesth Analg 1979;58:124132低灌注导致的高乳酸患者，PH7.(2)灌注压过低,导致分布到代谢活跃的组织中的血流不够，仍然不能满足组织代谢的需要。改变的指标将逐渐恢复至原有水平当血红蛋白低于70g/L时输注红细胞，使血红蛋白维持在7090g/L。Surviving Sep

5、sis Campaign:international guidelines for management of severe sepsis and septic shock:.其他培养：尿液、痰液、伤口分泌物等心输出量受到心脏前、后负荷与心肌收缩力等因素的影响,通常被描述为心脏的“泵功能”30持续24小时，病死率高达85%。白蛋白是一种天然的血浆蛋白质，构成了正常人血浆胶体渗透压的75%80%。Severe sepsis=sepsis-induced tissue hypoperfusion or organ dysfunction(any of the followingthought to

6、 be due to the infection)SvO2下降，提示机体无氧代谢增加。Sepsis-induced hypotension：Dellinger RP,Levy MM,Carlet JM,et al.A(高质量随机对照研究(RCT)或荟萃分析研究)渗透压(mmol/L)Dellinger RP,Carlet JM,Masur H,et al:Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock.Crit Care Med 2004;32:858873Delling

7、er RP,Levy MM,Carlet JM,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock:.Crit Care Med ;36(1):296-327.Dellinger RP,Levy MM,Carlet JM,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock:.Cr

8、it Care Med ;36(1):296-327.Dellinger RP,Levy MM,Carlet JM,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock:.Crit Care Med ;36(1):296-327.Dellinger RP,Levy MM,Carlet JM,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock:.Crit Care Med ;36(1):296-327.