文档介绍：感染性休克早期目标治疗
兰州军区总医院急救中心&重症医学科李新宇
指南、进展、临床实践
肛周及右下肢肿痛伴间断发热8天,加重伴呼吸困难的2天;
肛周脓肿、严重脓毒症、感染性休克、MODS(呼吸、循环、凝血、肝、肾)
Is plex condition-often life threatening
Affects 750,000 patients in the US
Accounts for 215,000 deaths
Costs $16 billion/year
Mortality 40-60%
What Is Sepsis
Definition of Sepsis
Infection
Other
Burns
Trauma
Pancreatiits
Fungemia
Parisitemia
Viremia
Other
Bacteremia
Bone et al Chest 1992
SIRS
Sepsis
The Continuum of Sepsis
Bone et al. Chest 1992;101:1644
Sepsis
SIRS
Severe Sepsis
Systemic Inflammatory Response Syndrome
SIRS criteria
Temp < 36° or > 38° C
HR > 90
RR > 20 or PCO2 < 32
WBC < 4 or > 12 or bands > 10%
Septic Shock
The Continuum of Sepsis
Sepsis
SIRS
Severe Sepsis
Septic Shock
Systemic Inflammatory Response to Infection
Suspected or confirmed infection
2 or more SIRS criteria
Bone et al. Chest 1992;101:1644; Balk, RA
The Continuum of Sepsis
Sepsis
SIRS
Severe Sepsis
Septic Shock
Sepsis an Dysfunction
Elevated Creatinine
Elevated INR
Altered Mental Status
Elevated Lactate
Hypotension that responds to fluid
Bone et al. Chest 1992;101:1644
The Continuum of Sepsis
Sepsis
SIRS
Severe Sepsis
Septic Shock
Severe Sepsis and Hypotension
Hypotension that does NOT respond to fluid (/kg bolus)
Bone et al. Chest 1992;101:1644
Sepsis
SIRS w/ presumed
or confirmed infection
Severe
Sepsis
Sepsis with ≥1 sign
an failure:
Refractory Hypotension
Renal
Respiratory
Hepatic
Hematologic
CNS
Metabolic acidosis
SEPTIC
SHOCK
%
%
%
PRIMARY SOURCES:
Pneumonia
Urinary
Abdomen or Surgical wound
脓毒症及内***血症
全身血管扩张及急性肾功能不全
液体摄入过多
肺水肿、组织缺氧
机械通气
感染
急性呼吸窘迫综合征
多器官功能障碍
组织间液增多
死亡率80%~90%
白蛋白渗出增多
静水压改变