危重病的早期预警.ppt

内容;什么叫重症医学;早期发现并积极处理危重症

----提高抢救成功率的关键;病情的突然变化

-----病情变化被突然发现;从不同部门入ICU患者死亡率的差别;HillmanKM等前瞻性研究了551例从不同科室入ICU患者情况：90例来自普通病房，239例来自OR，222例来自ED。普通病房入ICU患者APACHEII评分21，OR15，ED19；死亡率分别为47.6%、OR19.3%、ED31.5%；入ICU前经历的不良事件：普通病房72%、OR64.4%、ED61.8%。入ICU前8小时常见的不良事件：hypotension(n=199),tachycardian=73),tachypnoea(n=64),andsuddenchangeinlevelofconsciousness(n=42).;危重病的早期预警;

Multiple-parameteroraggregateweightedscoringsystemsusedfortrackand

triggersystemsshouldmeasure:

?heartrate

?respiratoryrate

?systolicbloodpressure

?levelofconsciousness

?oxygensaturation

?temperature.;

Inspecificclinicalcircumstances,additionalmonitoringshouldbeconsidered;

forexample:

?hourlyurineoutput

?biochemicalanalysis,suchaslactate,bloodglucose,basedeficit,arterialpH

?painassessment.;危重病的早期预警;改良早期危险评分（MEWS);JournalofCriticalCare(2012)27,424.e7–424.e13;Contentofmeasurements.Thecombination(inwhite)ofallmeasurementstaken(N=2688)isshowncomparedwiththemeasurementswithapositiveMEWS(≥3points)inblack(n=988).Allpossiblecombinationswereanalyzed,andthosewithaprevalenceof4%ormorewereincluded.BPindicatessystolicbloodpressure;Resp,respiratoryrate;Temp,temperature;Sat,peripheralsaturationwithsupplementaryoxygentherapy;EarlyWarningScorescoringsystem

EWS3210123

Pulserate51-100101-110111-130130

BP(systolic)7070-8081-100101-200200

Respiratoryrate99-1415-2021-3030

Temperature35.135.1-36.536.6-37.537.5

ConsciousnessAVPU

EWS=EarlyWarningScore;BP=bloodpressure;A=alert;V=responsivetovoice;P=res