文档介绍：Management of Severe Sepsis and Septic Shock An Evidence-Based Approach
Septic Shock
SIRS, plus evidence of
Infection, an
Failure, plus refractory
Hypotension
215,000 cases
Number of death/yr
90,000
Mortality 45%
Number of death/yr
60,000
Mortality 15%
Number of death/yr
60,000
Mortality 20%
Systemic
Inflammatory
Response
Syndrome
(SIRS)
2 of the following
BT 38oC Or <36oC
Pulse 90 min
Respirations 20min
White cells >12000
Or <4000 min or
>10% band forms
SEPSIS
SIRS, plus evidence
of Infection
400,000 cases
Severe Sepsis
SIRS, plus evidence
of Infection, an failure
300,000 cases
Cytokine level, Organ Failure and Mortality of Severe sepsis
所有患者
存活者
死亡者
P value
Disease severity
C-reactive protein (mg/dl)
12 (-12)
12 (-12)
12 (-12)
NS
APACHE II score
28 (15-53)
26 (15-38)
32 (17-53)
<
Septic shock, n(%)
42 (67)
25 (57)
17 (90)
No. of an systems, n(%)
3 (1-5)
2 (1-5)
4 (2-5)
<
1, n(%)
16 (25)
16 (36)
0 (0)
2, n(%)
14 (22)
13 (30)
1 (5)
3, n(%)
15 (24)
8 (18)
7 (37)
4, n(%)
12 (19)
5 (11)
7 (37)
5, n(%)
6 (10)
2 (5)
4 (21)
Cytokine levels
Interleukin-6, pg/ml
419 (10-4931)
237 (10-4931)
1341 (507-4272)
<
Tumor necrosis factor-, pg/ml
49 (6-253)
42 (6-175)
94 (27-253)
<
Infection site
NS
Lung, n(%)
38 (60)
29 (66)
9 (47)
Urinary tract, n(%)
8 (13)
6 (14)
2 (11)
Abdomen, n(%)
12 (19)
6 (14)
6 (32)
Others§, n(%)
5 (8)
3 (7)
2 (11)
Positive blood culture, n(%)
21 (33)
12 (27)
9 (47)
NS
Excessive inflammatory mediator production during sepsis
(Riedemann et al. Nat Med 2003;9:517)
Pro-inflammatory
cytokines +
chemokines
ROS production
Enzyme release
Vascular permeability
Bacterial killing
DIC
Tachypnea
Fever
Leukocytosis
Tachycardia
Peripheral resistance
Edema
Tissue an failure
Leukocytopenia
Shutdown of neutrophil &
Phagocytic cell function
Susceptibility to infection
HYPERREACTIVE
IMMUNE RESPONSE
HYPOREACTIVE
IMMUNE RESPONSE,
IMMUNE PA