必威体育精装版感染性休克教材.ppt

病例1 神志恍惚，呼之略有反应。 体温39.8摄氏度，血压70/50mmHg，心率102次/分，呼吸32次/分 瞳孔大小、对光反射正常，颈部软，病理征（-）。唇轻度紫绀。双肺野可闻及散在哮鸣音，双下肺湿罗音。腹部（-）。 躯干和四肢皮肤弹性正常。 病例1 监测中心静脉压（深静脉穿刺置管）。 监测尿量（导尿并留置尿管）。 液体复苏（用什么？ 用多少？） 急查：血气分析、血生化、电解质、乳酸、血常规、尿常规、留标本（痰、血）做菌培养 胸片，心电图 抗生素治疗（用什么？怎么用？） 病例1 血气分析： pH 7.186; PaO2 66mmHg; PaCO2 40mmHg; HCO3- 19mmol/L; BE -8 mmol/L。（相应处理？） 液体复苏1小时，使用晶体液1200ml，胶体液500ml，血压75/55mmHg，心率120次/分，尿量15ml/小时。 ScVO2 0.61，血乳酸浓度 8.4mmol/L Thank you ! * * * * Rivers et al conducted a randomized, non-blinded trial of standard therapy vs early, goal-directed therapy (EGT) in patients with SIRS criteria and systolic blood pressure (BP) ?90 mm Hg unresponsive to 20 mL/kg of crystalloids, or a lactate ?4 mmol/L. Two hundred and sixty-three patients met the entry criteria and were randomized to either standard therapy (n=133) or EGT (n=130). Patients were monitored by vital signs, laboratory data, cardiac monitoring, pulse oximetry, urinary catheterization, arterial and central venous catheterization. Standard therapy was administered by protocol with critical care consultation and consisted of measures to maintain a CVP of ?8-12 mm Hg, MAP ?65 mm Hg, and UOP of ?0.5 mL/kg/hr. Patients randomized to EGT received an oximetric central venous catheter (CVC) capable of measuring SVO2 and were treated early in the emergency department according to protocol for at least 6 hours before they were transferred to the first available inpatient bed. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77. * Patients treated with EGT received approximately 1.5 liters of fluids during the first 6 hours (3500 vs 5000 mL). In addition, patients treated with EGT received significantly more RBC transfusions (64.1% vs 18.5%). There were no significant differences in vasopressor support during the first 6 hours; however, the EGT group received significantly more vasopressors after 7 hours than did the standard group. While l