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危重病

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关于脓毒症近期文献的精华
原作者: Michael Winters,李辉翻译 文章来源: 《中华急诊医学杂志》编辑部 发布日期:2015-02-28

Title: Sepsis Pearls from the Recent Literature

题目:关于脓毒症近期文献的精华

Author 作者: Michael Winters

翻译:李辉 校对:肖锋

 

 

• Sepsis remains one of the most common critical illnesses managed by emergency physicians and intensivists.

• 脓毒症依然是急诊和重症医学医生最常处理的危重病。

• Recent publications and meta-analyses (i.e., ProCESS, ALBIOS, SEPSISPAM) have further refined the management of these complex patients.

• 近期的论文及Meta分析(比如:ProCESS, ALBIOS, SEPSISPAM)进一步精炼了这些复杂病人的处理。

• A few pearls from the recent literature:

• 近期文献的一些精华

Early broad-spectrum antibiotics remains the most important factor in reducing morbidity and mortality.

早期广谱抗菌素依然是降低发病率和死亡率的重要因素。

Appropriate fluid resuscitation with a balanced crystalloid solution targeting 30 ml/kg. Use a dynamic measure of volume responsiveness to determine if additional fluid needed (i.e., PLR with a minimally invasive or noninvasive cardiac output monitor)

以30ml/kg平衡晶体液为目标的适当的液体复苏。动态评估容量反应性,决定是否需要额外的液体(即,被动抬腿试验结合侵入性或非侵入性的心输出量监测)。

Maintain adequate tissue perfusion with IVFs and vasopressors (norepinephrine) targeting a MAP > 65 mm Hg. Patients with chronic HTN may benefit from a higher MAP goal. If the diastolic BP is < 40 mm Hg upon presentation, start vasopressors concurrent with IVF resuscitation.

维持充足的组织灌注包括静脉补液以及升压药(去甲肾上腺素),目标为平均动脉压>65mmHg。慢性高血压患者可能会受益于较高的平均动脉压目标值。如果舒张压<40mmHg,静脉补液同时使用升压药。

References 参考文献:

1 Marik PE. Early management of severe sepsis: concepts and controversies. Chest 2014; 145:1407-1418.
http://www.ncbi.nlm.nih.gov/pubmed/24889440

2 Rochwerg B, et al. Fluid resuscitation in sepsis: a systematic review and network meta-analysis. Ann Intern Med 2014 [epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/25047428

3 Raghunathan K, et al. Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis. Crit Care Med, 2014; 42:1585-1591.
http://www.ncbi.nlm.nih.gov/pubmed/24674927
 

文章来源:《中华急诊医学杂志》编辑部