1、Sepsis = Infection+SIRSSepsis = 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 outcome of pats admitted to ICU with sepsis9%29%38%61% 63%81%0%30%60%90%Mortality /%sepsis sspesis sshockAEATIEATCCM, 2003, 31
2、: 2742Annual incidence of severe sepsis: 3 cases/ 1,000 Kill: 1,400 people worldwide /d 25 people /hMoreover, No. of sepsis pats is projected to increase by 1.5% 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 Sepsis Compaign拯救Sepsis运动Surviving 巴塞罗那宣
3、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 sepsisAIM: 5 年内 Sepsis 死亡率减少25%第一阶段/Phase IDevelop guidelines Bedside clinician could use to improve outcome in severe sepsis ans septic shock 第二阶段/Phase IIESICM SCCM ISFAACCN/ACCP
4、/ACEP/ATS/ANZICS/ESCMID/ERS/SIFGuidelines for sepsis. Intensive Care Med 2004, 30: 536-555Guidelines for management of severe sepsis/ septic shockInitial resuscitation: early goal-directed therapyDiagnosis: appropriate cultureAntibiotic therapy: Early broad-spectrum, reassessed 2-3d Source control:
5、Fluid therapy: colloids=crystalloids,VLTVasopressors: After VLS, NE vs Dopa, Low-dose dopa is not , cath for vaso Inotropic therapy: low CO-dobu, high CO is notSteroid: low dose rhAPC: APACHE II 25, sepsis-induced ARDS/MOF and no bleeding risk第二阶段/Phase IIGuidelines for management of severe sepsis/s
6、eptic shockBlood product administration: target Hb 7-9g/dl, EPO only in renal failureMechanical ventilation: Ppla30, Hypercapnia, optimal PEEP, Prone positionSedation, analgesia and NBMs: ProtocolGlucose control: 150mg%Renal replacement: Bicarbonate: pH 7.15DVT: UH/LMWHStress ulcer prophylaxis: H2blocker第二阶段/Phase IITo use the management guidelinesTo evalute the impact on clinical outcome of severe sepsis第三阶段/Phase IIIESICM SCCM ISFAACCN/ACCP/ACEP/ATS/ANZICS/ESCMID/ERS/SIF
