严重感染治疗策略.ppt

严重感染
的抗感染策略
重症感染的重要性
细菌耐药机制及ICU细菌流行情况
重症感染的治疗策略
-感染灶的充分引流
-早期经验性治疗
-正确的目标性治疗
内容提要
Sepsis = Infection+SIRS
细菌侵入
临床体征
infection损伤 SIRS sepsis
severe sepsis

septic shock MODS/ MOF
感染过程
Impact of adequate empirical antibiotic therapy on the e of pats admitted to ICU with sepsis
CCM, 2003, 31: 2742
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 % 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
Sepsis in worldwide
Surviving paign拯救Sepsis运动
巴塞罗那宣言
ESICM SCCM ISF 2002年10月2日, 西班牙
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、卫生机构甚至公众支持该行动
Improve survival in severe sepsis
AIM: 5年内Sepsis死亡率减少25%
第一阶段/Phase I
Develop guidelines
Bedside clinician could use to improve e in severe sepsis ans septic shock
第二阶段/Phase II
ESICM SCCM ISF
/ACCP/ACEP/ATS/ANZICS/ESCMID/ERS/SIF
Guidelines for sepsis. Intensive Care Med 2004, 30: 536-555
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
第二阶段/Phase II