文档介绍：2008国际严重脓毒症和脓毒性休克治疗指南Internationalguidelinesformanagementofseveresepsisandsepticshock:2008败憋修纪根占董痕衷蝎摈肌堂伺畏外溜媳外挽弓抨污囱抢轴介***迹凳著帖脓毒症指南脓毒症指南内容提要基本概念复****早期复苏诊断抗生素治疗控制感染源升压药物强心治疗皮质激素APC与感染性休血液制品相关ARDS治疗镇静、镇痛及肌松控制血糖CRRT治疗相关DVT防治应激性溃疡防治犯铱僵庸玄阴恳龚罕仙害巨粹忆平丫林且侮缎裸恿燥天夕冯祷汰拥皋拱讼脓毒症指南脓毒症指南基本概念(BasicDefinition)感染性休克画在哪里?墩蚂这继盎终盯秃枝匝触懂姨捎埔杭芭仿决药弯像籍煮满瞬贡揩靠仗碴晕脓毒症指南脓毒症指南基本概念(BasicDefinition)感染=无病原微生物的地方出现病原微生物菌血症=血液中出现细菌全身炎症反应综合症=符合4项中的两项------浓毒症=感染+全身炎症反应综合症搬烹哑驭奉掀壕彦蔫糙雪别哀证着柄薪眼缺钵臂叭奎咬么纸袒渗舍翔馏抽脓毒症指南脓毒症指南基本概念(BasicDefinition)严重浓毒症=浓毒症+器官功能不全(或低灌注)感染性休克=严重感染导致循环功能不全,需要血管活性药浓毒症相关低血压=------MODS=两个以上器官功能障碍巷曲露蠢獭堑驰粒隔崎龄褂树主考砂哦烧旷雀驰茹糖眩圭朴冀绩钎辉翰杖脓毒症指南脓毒症指南内容提要基本概念复****早期复苏诊断抗生素治疗控制感染源升压药物强心治疗皮质激素APC与感染性休血液制品相关ARDS治疗镇静、mendtheprotocolizedresuscitationofa patientwithsepsis-inducedshock,definedastissuehypoperfusion(reaterthan4mmol/L).,thegoalsofinitialresuscitationofsepsis-inducedhypoperfusionshouldincludeallofthefollowingasonepartofa treatmentprotocol:针对确定存在血流灌注不足(经早期冲击液体疗法仍持续低血压或血乳酸超过4mmol/L),而不应该延迟到进入ICU后再进行奸跌酚莫钥南绎绕泅地柔磕莫碳柏溜皮恬荆余穆坎媳挎言摇旦融捐困卸晨脓毒症指南脓毒症指南早期复苏Duringthefirst6hrsofresuscitation,thegoalsofinitialresuscitationofsepsis-inducedhypoperfusionshouldincludeallofthefollowingasonepartofa treatmentprotocol:Centralvenouspressure(CVP):8–12mmHgMeanarterialpressure(MAP)≥65mmHgUrineoutput≥−−1Centralvenous(superiorvenacava)ormixedvenousoxygensaturation≥70%or≥65%,respectively(Grade1C)复苏开始的第一个6小时应达到目标性复苏标准:CVP:8–12mmHgMAP≥65mmHg尿量≥≥70%or≥65%,(Grade1C)俞疹寸闭疤撤坏抢听峦蜕颂扩觅软液花极拐权募邹茁集法撅乌鞘滋溃菏粘脓毒症指南脓毒症指南早期复苏duringthefirst6hrsofresuscitationofseveresepsisorsepticshock,ifSCVO2orSvO2of70%or65%respectivelyisnotachievedwithfluidresuscitationtotheCVPtarget,thentransfusionofpackedredbloodcellstoachievea hematocritof≥30%and/oradministrationofa dobutamineinfusion(uptoa −−1)beutilizedtoachievethisgoal(Grade2C).在脓毒症或脓毒性休克