資源描述：
《膿毒癥的液體治療ppt課件》由會員上傳分享，免費(fèi)在線閱讀，更多相關(guān)內(nèi)容在教育資源-天天文庫。
1、膿毒癥的液體治療 —VISEP試驗(yàn)解讀EpidemiologyManagement:guidelinesInitialresuscitationDiagnosisAntibiotictherapySourcecontrolFluidtherapyVasopressorsInotropictherapySteroidsRhAPCBloodproductadministrationk.Mechanicalventilationl.Sedationm.Glucosecontroln.Renalreplacemento.Bicarbonatetherapyp.Deepveinthrombosisp
2、rophylaxisq.StressulcerprophylaxisDellingerRIntCareMed2004;30:536-555早期復(fù)蘇治療?EarlyGoal-DirectedTherapy??早期目標(biāo)治療RiversENEnglJMed2001;345:1368-77單一中心臨床研究263個急診科收治病人有嚴(yán)重感染或感染性休克隨機(jī)化:EGDTvs常規(guī)治療結(jié)果:醫(yī)院死亡率(28d)<6HRandomizationEGDTEarlyGoalDirectedTherapy:ResultsEGDT:?mortality16%at28d12%at60dRiversENEnglJMed2
3、001;345:1368-77液體復(fù)蘇感染性休克>>低容量>>積極液體復(fù)蘇治療容量試驗(yàn):500-1000ml晶體或300-500ml膠體30min內(nèi)輸完，評估病人的反應(yīng)晶體或膠體??目前尚無循證醫(yī)學(xué)證據(jù)支持哪一類!DellingerCritCareMed2003;31:946-955ShouldwetransfuseRedBloodCells?AMulticenter,Randomized,ControlledClinicalTrial ofTransfusionRequirementsinCriticalCareHebertetal.N.Engl.J.Med.1999,340:409-1
4、7Acomparisonofalbuminandsaline forfluidresuscitationintheICUProbabilityofSurvival0,5028AlbuminN-Saline1,0FinferSetal.NEnglJMed2004;350:2247-56RCTstydy6997PatientsControlgroup:N-SalineStudygroup:4%AlbuminMetaAnalysisAlbuminvs.CrystalloidsCochraneStudyGroupBMJ1998;317:235.MortalityRelativerisk：Albvs
5、CrystAlbuminControlHypovolaemia38/25626/2781.46(0.97-2.22)Burns19/818/822.40(1.11-5.19)Hypoalbumin-41/25924/2481.69(1.07-2.57)aemiaTotal98/59658/6081.68(1.26-2.23)Conclusion:AlbuminincreasedriskofmortalityMulticentertrialAlbuminvs.CrystalloidsSAFEStudyAustralia/NewZealand6997patients:3497albumin,3
6、500normalsalineMortality:726p.albumin,729p.normalsalineSingleorganfailurenodifferenceICUdays:6.5dalbumin,6.2dnormalsalineVent.days:4.5dalbumin,4.3dnormalsalineRenalreplacement:0.5dalbumin,0.4dsalineOutcome:28dmortalitysimilarAUS/NZInt.CareSoc.Clin.TrialGroupNEJM2004;350:2247-56SAFEstudy任何死亡原因的相對風(fēng)險
7、度0.51.02.0AlbuminBetterSalineBetter0.99(0.91-1,09)1.36(0.99-1.86)0.96(0.88-1.06)0.87(0.74-1.02)1.05(0.94-1.17)0.93(0.61-1.41)1.00(0.91-1.09)總數(shù)726/3473729/3460創(chuàng)傷是81/59659/590否641/2831666/2830重度膿毒血癥是185/603217/615否
