2020脓毒症指南课件

According to the assessment requirements of party conduct and clean government, combined with the "five regulations" and "fiv e new requirements" of state-owned Enterprise leaders ' integrity and self-discipline
SIRS 临床发病过程
局部 促炎介质
原始病因 感染因子 非感染因子
局部 抗炎介质
促炎介质 过度产生
抗炎介质 过度产生
全身反应
全身炎症反应综合征 （SIRS） 代偿性炎症反应综合征（CARS） 混合性抗炎反应综合征（MARS）
SIRS和CARS 稳态
SIRS占优 休克
SIRS占优 细胞调亡
SIRS占优 MODS
A 初期复苏EGDT
1.复苏的最初6小时目标
• 1) CVP 8-12 mmHg Mechanical Ventilation 12-15mmHg
• 2) MAP
≥65mmHg
• 3)Urine Output
≥0.5ml/kg/h
• 4)ScvO2≥70% 或 SvO2≥65% （1C）
10.87-16.31 cmH2O
脓毒症
Sepsis
由于微生物或其他病原体侵 入人体而诱发的过度激烈全身炎 症反应，并对组织具有损伤的病 理生理过程及一组临床表现
According to the assessment requirements of party conduct and clean government, combined with the "five regulations" and "fiv e new requirements" of state-owned Enterprise leaders ' integrity and self-discipline
巴塞罗那宣言
Phase 1吁全球的医务人 员、卫生机构和政 府乃至公众应高度 认识和重视严重脓 毒症和脓毒症休克, 力争5 年内将全身 性感染患者的病死 率降低25 %作为 行动目标。
制定严重脓毒症和 脓毒症休克管理指 南,旨在提高对严 重感染的认识并努 力改善预后。
将致力于治疗指南 的临床应用和疗效 评估, 以期最终降 低严重脓毒症患者 的病死率。在评估 指南中临床疗效的 同时, 将根据临床 研究的进展和新的 依据, 每年对指南 进行修订。
According to the assessment requirements of party conduct and clean government, combined with the "five regulations" and "fiv e new requirements" of state-owned Enterprise leaders ' integrity and self-discipline
CARS占优 免疫功能障碍
According to the assessment requirements of party conduct and clean government, combined with the "five regulations" and "fiv e new requirements" of state-owned Enterprise leaders ' integrity and self-discipline
内 容：
液体复苏 诊断 抗生素治疗 病因治疗 血管收缩药 正性肌力药 皮质类固醇 活化蛋白C
血制品的使用 机械通气 镇静、镇痛和肌松剂 血糖控制 肾脏替代治疗 预防深静脉血栓形成 预防应激性溃疡 选择性肠道净化治疗
According to the assessment requirements of party conduct and clean government, combined with the "five regulations" and "fiv e new requirements" of state-owned Enterprise leaders ' integrity and self-discipline
提议6h复苏时，若ScVO2 ＜70%(或ScVO2＜ 65%)，分别持续液体复 苏达到CVP目标，并输注浓缩红细胞达到Hct30%，和/或输注多巴酚 丁胺（最大剂量20ug/kg.min）（Grade 2C）
According to the assessment requirements of party conduct and clean government, combined with the "five regulations" and "fiv e new requirements" of state-owned Enterprise leaders ' integrity and self-discipline
Sepsis: Defining A Disease Continuum
Infection or Trauma
SIRS
Sepsis
Severe Sepsis
Adult Criteria
A clinical response arising from a
Nonspecific insult, including ≥ 2 of the
2004年，11个国际医学组织的感 染和脓毒症诊治方面的专家，出 版了第一个改进重症脓毒症和脓 毒症休克预后的指南。这些指南 代表了拯救脓毒症运动（SSC）的 第Ⅱ阶段，一个国际性努力来提 高对重症脓毒症的认识和改善它 的预后。联合另外的一些组织， 这个工作组在2006年和2007年再 次举行会议，用新的循证方法论 系统来评估证据的质量和推荐力 度，以更新该指南文件。这些建 议的目的是用来指导临床医生治 疗重症脓毒症和脓毒症性休克的 病人。需要指出的是，当医生面 对具体病人独特的临床指标时， 这些指南中的建议不能取代临床 医生的决策。
2012年严重脓毒症和脓毒性休克治疗指南
According to the assessment requirements of party conduct and clean government, combined with the "five regulations" and "fiv e new requirements" of state-owned Enterprise leaders ' integrity and self-discipline
According to the assessment requirements of party conduct and clean government, combined with the "five regulations" and "fiv e new requirements" of state-owned Enterprise leaders ' integrity and self-discipline
概念
严重脓毒症：指脓毒症伴有器官功能障碍或组 织灌注不良
组织灌注不良：乳酸升高或少尿 脓毒性休克：充分液体复苏后仍持续低血压
According to the assessment requirements of party conduct and clean government, combined with the "five regulations" and "fiv e new requirements" of state-owned Enterprise leaders ' integrity and self-discipline
脓毒症流行病学：
美国每年发生严重脓毒症人数＞ 750,000
病死率高达30%～50%
每小时有25名患者死于严重感 染或感染性休克
是ICU的首要致死原因
是第10位致死原因
死亡率与急性心梗相近！
Angus DC, et a1. Crit Care Med,2001,29;1303-10
According to the assessment requirements of party conduct and clean government, combined with the "five regulations" and "fiv e new requirements" of state-owned Enterprise leaders ' integrity and self-discipline
Sepsis with ≥ 1 sign of organ dysfunction
According to the assessment requirements of party conduct and clean government, combined with the "five regulations" and "fiv e new requirements" of state-owned Enterprise leaders ' integrity and self-discipline
SIRS 本质
➢ 是机体过多释放炎症介质
➢ 是机体对各种刺激炎症反应