脓毒症PPT幻灯片课件.ppt

Do we need a new definition of sepsis?  ……the definition of septic shock currently revolves around variable blood pressure and/or lactate levels, with loosely termed or undefined ‘adequacy of fluid resuscitation’ and ‘persistent’ hypotension. Defining sepsis must, however, be an ongoing iterative process requiring minor or major revisions as new findings come to light. In much the same way that software enhancements move from version 1.0 to 1.1 or to 2.0 depending on the magnitude of change, so a new sepsis 3.0 definition must be refined into versions 3.1, 3.2, and so on until an eventual complete overhaul generates the development of sepsis 4.0. Intensive Care Med, 2015, 41 (5): 909-911. 脓毒症的诊断标准于1991年发布（脓毒症1.0）,但过于敏感，可能导致脓毒症的过度诊断和治疗；2001年更新版（脓毒症2.0）又过于复杂，未被广泛应用。 * Sepsis 3.0“应运而生” JAMA. 2016 Feb 23;315(8):801-10｀ * Sepsis 3.0定义 JAMA. 2016 Feb 23;315(8):801-10｀ Mortality 10% * Sepsis 3.0＝Infection＋SOFA≥2 Sepsis 3.0诊断标准 JAMA. 2016 Feb 23;315(8):801-10 * Septic shock 定义及诊断标准 JAMA. 2016 Feb 23;315(8):801-10 Mortality 40% Septic shock=Sepsis+输液无反应低血压+使用缩血管药物维持MAP≥65mmHg）+乳酸则＞2mmol/L。 Septic shock is a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality. * 脓毒症3.0诊断流程 JAMA. 2016 Feb 23;315(8):801-10 * ACCP反对Sepsis 3.0 1.Given that use of the current definitions results in saving lives, it seems unwise to change course in midstream by shifting the definition. This is especially true because there is still no known precise pathophysiological feature that defines sepsis. 2.Abandoning the use of SIRS to focus on findings that are more highly predictive of death could encourage waiting, rather than early, aggressive intervention. This is a mistake that we cannot make. 3.To abandon one system of recognizing sepsis because it is imperfect and not yet in universal use for another system that is used even less seems unwise without prospective validation of the new system’s utility.