全身炎癥反應(yīng)綜合癥與膿毒血癥上-資料下載頁
2025-08-15 09:16本頁面
【導讀】1991年8月，美國胸科醫(yī)師學院和美國危重病。膿毒性休克低血壓。無論任何原因所導致的系統(tǒng)內(nèi)在的免疫反應(yīng)的。激活；可由下述因素觸發(fā)：局部或全身感染，體溫：>38℃或<35℃;心率：>90次/分；呼吸>20次/分；或PaCO2<32mmHg;WBC:>12*109/L,<4*109/L,或未成熟粒細胞。由感染引起的全身炎癥反應(yīng)，證實有細菌存在。在膿毒血癥/SIRS的基礎(chǔ)上出現(xiàn)器官功能障礙，乳酸性酸中毒，少尿或急性意識狀態(tài)改變。充分的液體復蘇后血壓仍不能恢復到正常水平。多種外科嚴重疾病如。至死亡的整個過程。多個系統(tǒng)參與的炎癥反應(yīng)貫穿這一病程，主要。中性粒細胞及內(nèi)皮細胞的黏附反應(yīng)、微循環(huán)障礙和補體及凝血系統(tǒng)影響。失控，產(chǎn)生過度的炎癥反應(yīng)，造成機體的損傷，且治療費用昂貴的疾病。在美國每年有750，000人死于嚴重膿毒。血癥，也是ICU的最常見的死亡原因。據(jù)CDC報告近10年間，嚴重膿毒血癥病。至20xx年，嚴重膿毒血。正常情況下，機體的自身防。機體內(nèi)任何部位的任何一種。SIRS診斷過度敏感和缺乏特異性。對膿毒血癥的診斷提出擴展的診斷標準，
【正文】 ilirubin 23 mg/dL or other liver function tests more than twice normal, PT elevated to twice normal ? Jaundice with bilirubin 810 mg/dL ? Gastrointestinal ? Intolerance of gastric feeding for more than 5 days ? Stress ulceration with need for transfusion, acalculous cholecystitis ? Hematologic ? aPTT 125% of normal, platelets 5080,000 ? Disseminated intravascular coagulation ? Cardiovascular ? Decreased ejection fraction with persistent capillary leak ? Hyperdynamic state not responsive to pressors ? CNS ? Confusion ? Coma ? Peripheral nervous system ? Mild sensory neuropathy ? Combined motor and sensory deficit Oliguria ? Marker of hypoperfusion ? Urine output in adults mL/kg/hr for 2 hrs ? Etiologies ? Prerenal ? Renal ? Postrenal Evaluation of Oliguria ? History and physical examination ? Laboratory evaluation ? Urine sodium ? Urine osmolality or specific gravity ? BUN, creatinine Evaluation of Oliguria ? Laboratory Test Prerenal ATN ? Blood Urea Nitrogen/ 20 10–20 Retaining Ratio ? Urine Specific Gravity ? Urine Osmolality (mOsm/L) ? 500 350 ? Urinary Sodium (mEq/L) ? 20 40 ? Fractional Excretion of Sodium (%) ? 1 2 Therapy in Acute Renal Insufficiency ? Correct underlying cause ? Monitor urine output ? Assure euvolemia ? Diuretics not therapeutic ? Lowdose dopamine may ? urine flow ? Adjust dosages of other drugs ? Monitor electrolytes, BUN, creatinine ? Consider dialysis or hemofiltration
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