脓毒血症的多学科救治进展-课件.pptx

Fudan University Huashan Hospital Department of Infectious Diseases 脓毒症临床多学科救治进展复旦大学附属华山医院感染科张文宏 2016 7 月青岛感染病专业覆盖面?抗菌药物治疗?血流感染?脓毒症? FUO ?骨关节感染?中枢神经系统感染,脑膜炎?心内膜炎?骨髓炎?肺炎?移植相关感染?免疫低下相关感染(预防与治疗) ?术后感染?病毒感染? HIV 感染与 AIDS ? HCV 感染?流感?寄生虫感染?性传播疾病?旅游相关疾病(预防与治疗) ?结核病?院内感染‘ The main factor in all inflammatory states consists in a lesion of the vessels which are attacked by the irritating cause. ’ Elias Metchnikoff , 1845 – 1916 脓毒血症的病理生理本质 Inthe old book-1992 ? Sepsis: a systemic inflammatory response to infection (SIRS), popularly described as a ‘ cytokine storm ’ . Repeatedly criticized as non- specific! Systemic inflammatory response can be caused by non-microbial ‘ irritating causes ’, such as autoimmune, metabolic or physical insults. The ACCP/SCCM Consensus mittee. American College of Chest Physicians/Society of Critical Care Medicine. 1992 脓毒血症概念的起源? SIRS: 各种损伤引起的临床反应,符合: ?符合 2个或 2个以上下面的条件: ? T >38 o C or <36 o C ? HR >90 beats/min ? RR>20 breaths/min or PaCO 2 <32mmHg ? WBC>12000/L or <4000/L ,or >10% immature forms Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012. Intensive Care Med (2013) 39:165 – 228 “ Sepsis ” is best defined as the systemic inflammatory response syndrome (SIRS) caused by microbial products. 感染全身炎症反应综合征脓毒血症严重脓毒血症脓毒症:感染引起的全身炎症反应综合征老概念:关注体征与症状( 版本) 6 Sepsis definition @ 1992 Sepsis SIRS Infection or Trauma Severe Sepsis Se ptic S hock MODS Sepsis induced hypoperfusion ≥ an dysfunction Sepsis Hypotension Adequate fluid resuscitation T P R W ≥ 2 SIRS ≥ 2 + infection ≥ ans Bone et al. Chest. 1992; 101(6):1644-1655. 7 Sepsis definition @ 2003 Sepsis Expanded clinical and laboratory variables Infection or Trauma Severe Sepsis Se ptic S hock MODS Sepsis induced hypoperfusion ≥ an dysfunction Sepsis Hypotension Adequate fluid resuscitation 5 items 24 parameters Some of + infection ≥ ans Levy MM, et al. Crit Care Med. 2003 Apr;31(4):1250