休克和感染性休克治疗指南课件.ppt

休克和感染性休克治疗指南;休克的概念; 低血容量休克的常见病因; 分布性休克常见病因;休克的血流动力学分类及其特点;休克的诊断;组织灌注不足的征象;;休克的分类;按血流动力学变化分类;;感染性休克;【病因】： ;【病理生理】： ;【血流动学特点】： ;感染性休克的临床表现;【诊断】： ;背景;*Angus DC. Crit Care Med. 2001 (In Press).;Annual incidence of severe sepsis: 3 cases/ 1,000 Kill: 1,400 people worldwide /d 25 people /h Moreover, No. of sepsis pats is projected to increase by 1.5% per annum 严重感染的病死人数超过乳腺癌、直肠癌、结肠癌、胰腺癌和前列腺癌的总和 严重感染 vs AMI:发病率相同，病死率明显高;?National Center for Health Statistics, 2001. §American Cancer Society, 2001. *American Heart Association. 2000. ?Angus DC et al. Crit Care Med. 2001 (In Press). ;Surviving Sepsis Compaign拯救Sepsis运动(SSC);全球Sepsis的发病率和死亡率均很高，耗费大量的人力物力 呼吁全球 医务专业人员和组织、政府、卫生机构甚至公众重视和支持该行动 Improve survival in severe sepsis 行动目标： 5年内Sepsis死亡率减少25%; 制定治疗指南 Develop guidelines Bedside clinician could use to improve outcome in severe sepsis and septic shock ;Guidelines for management of severe sepsis/ septic shock Initial resuscitation: early goal-directed therapy Diagnosis: appropriate culture Antibiotic therapy: Early broad-spectrum, reassessed 2-3d Source control: Fluid therapy: colloids=crystalloids,VLT Vasopressors: After VLS, NE vs Dopa, Low-dose dopa is not , cath for vaso Inotropic therapy: low CO-dobu, high CO is not Steroid: low dose rhAPC: APACHE II 25, sepsis-induced ARDS/MOF and no bleeding risk;Guidelines for management of severe sepsis/septic shock Blood product administration: target Hb 7-9g/dl, EPO only in renal failure Mechanical ventilation: Ppla30, Hypercapnia, optimal PEEP, Prone position Sedation, analgesia and NBMs: Protocol Glucose control: 150mg% Renal replacement: Bicarbonate: pH 7.15 DVT: UH/LMWH Stress ulcer prophylaxis: H2blocker;致力于指南的临床应用和疗效评估，以期最终降低脓毒症病死率。同时，根据临床研究进展和新的依据对指南进修改。 To use the management guidelines To evalute the impact on clinical outcome of severe sepsis;Sepsis = Infection+SIRS; infection损伤 SIRS sepsis