低血压,严重脓毒血症,脓毒血症休克的临床诊治路径.pptx

低血压、严重脓毒症、脓毒性休克急诊处置临床路径

王真

首都医科大学附属北京世纪坛医院;

低血压急诊处置路径;;;;;;;;

血管活性药物的选择

(1)多巴胺作用于多巴胺受体、β1-受体和α-受体。1-

kgi(mi主n)要,作B血-受管体扩，张增，强增心加肌尿收量缩；能2力-1μ增g.加心输

出量，也增加心肌氧耗；10μg(kg-min)时以α-受体兴奋

为主，收缩血管。

(2)多巴酚丁胺β1、β2受体激动剂，使心肌收缩力增强，血管扩张和减少后负荷。

(3)去甲肾上腺素，主要效应是增加外周阻力来提高血压，同时也不同程度地收缩冠状动脉。;;;;;;

严重脓毒症及脓毒性休克急诊处置路径;

Sepsis-

knownsincetheancienttimesofhumanhistor;

Leadingcauseofdeathinthenon-coronaryICU.

750,000newcasesthatoccurintheUnitedStateseachyear.

Growatarateof1.5%peryearasmedicinebecomesmoreaggressive.

Mortalityis30%to50%forseveresepsisand50%to60%forsepticshock.

Accountingfor40%oftotalICUexpenditure

DlingetRP,CarletMMasurH,GethchHClandnT,CohenJ,Ge-BanadocdheI,KchD,MarshallICPakeeMMRamsayG,

zimmemnLVincentjLLeyMMandtheSSCMangcmentGuidcinesComnittce.CCnMa200432:858-8731mtmCnMad2004;30:536-555;

Burns

Adaptedfrom:BoneRCetal.Chest.1992;101:1644-55.

OpalSMetal.CritCareMed.2000;28:S81-2.;

40

35

30

25

20

15

10

5

0

TraumaAcuteMI;

Sepsis

86%saidthatsymptomsofsepsiscaneasily

bemisattributedtootherconditions.;;

■严重脓毒症

SBP90mmHg

MAP65mmHg

·SBP下降大于基础血压40%

·肌酐2.0mg/d(176.8mmoVL)

·超过2小时排尿量0.5ml/kg/hour·胆红素2.0mg/d(34.2mmol/L)·血小板计数100000;

SponsoringOrganizations

AmericanAssociationofCriticalCareNurses

■AmericanCollegeofChestPhysicians

AmericanCollegeofEmergeneyPhysicians

■AmericanThoracicSociety

■AustralianandNewZealandIntensiveCareSociety

BuropeanSocietyofClinicalMicrobiologyandInfectiousDiseases

■EuropeanSocietyofIntensiveCareMedicine

■BuropeanRespiratorySociety

■InternationalSepsisForum

SocietyofCriticalCareMedicineSurgicalInfectionSociety;

诊断突破--标志物?

■诊断?

■预后?

■敏感性?

异性?

口PCTandCRPhavebeenmostwidelyused,buteventhesehavelimited

abilityodistinguis