上交大外科学课件11-2外科全身性感染

Surgical Systemic Infection 外科全身性感染外科全身性感染 Infection 感染感染 Presence of organism in normally sterile site accompanied by an inflammatory host response 病源微生物病源微生物+宿主炎性反应宿主炎性反应 Systemic Inflammatory Response Syndrome (SIRS)全身炎症反应综合征全身炎症反应综合征 systemic inflammatory response without evidence of infection 全身炎症反应全身炎症反应+无感染的依据无感染的依据 体温、心率、呼吸、白细胞计数体温、心率、呼吸、白细胞计数 Systemic Inflammatory Response Syndrome 全身炎症反应综合征全身炎症反应综合征 Being manifested by at least 2 followings:T38 or T90 bpm RR 20 bpm or PaCO2 12000 or 39.5,change in mental status,hypotension,shock）白血病样反应白血病样反应 （WBC25,000/dl，晚幼粒、中幼粒）脓毒症的预后和死亡率脓毒症的预后和死亡率 Mortality&Prognosis of Sepsis Clinical signsClinical signs （临床表现）临床表现）Mortality Mortality raterate （死亡率）（死亡率）Fever,Leukocytosis（发热、白细胞升高）发热、白细胞升高）10%Multiple Organ Failure（多脏器衰竭）多脏器衰竭）64%Shock（休克）休克）69%Shock with MOF（休克休克+多脏器衰竭）多脏器衰竭）88%Total 42%脓毒症的治疗脓毒症的治疗 Treatment of Sepsis Debridement of primary infection（去除原发感染灶）Antibiotics therapy （合理应用抗生素）Supportive&Miscellaneous Therapy（支持和综合治疗）脓毒症的支持和综合治疗脓毒症的支持和综合治疗 Supportive&Miscellaneous Therapy Recovery of enteral nutrition as possible（恢复肠道营养）恢复肠道营养）Correction of acid-basis&electrolyte balance（纠正酸碱、水电失衡）纠正酸碱、水电失衡）Diuretics（利尿）利尿）Naloxone（纳络酮）纳络酮）Corticosteroids（皮质激素）皮质激素）Transfusion of leukocyte concentrate（输注白细胞）输注白细胞）Immunotherapy（免疫治疗）免疫治疗）