急危重癥的監(jiān)護ppt課件-資料下載頁
2025-03-22 06:11本頁面
【正文】 75 腎臟替代療法 ? 無法控制的高血鉀癥； ? 對利尿劑無反應(yīng)的嚴重水鈉潴留； ? 嚴重的尿毒癥； ? 嚴重酸中毒。 76 肝功能監(jiān)護 ? 血清膽紅素：評估肝臟排泄功能。 ? 血清白蛋白：評估肝臟合成功能。 ? 谷丙轉(zhuǎn)氨酶（ ALT）、谷草轉(zhuǎn)氨酶（ AST）：評估肝實質(zhì)細胞有否損傷。 ? 凝血酶原時間（ PT）：評估肝臟合成功能。凝血酶原時間和凝血因子 Ⅰ 、 Ⅴ 、 Ⅶ 和 Ⅹ 有關(guān)，而這些因子也均在肝臟合成。特別是 Ⅶ因子，是肝臟合成的半衰期短的凝血因子，半衰期 4～ 6h，是肝功能受損時最早減少的凝血因子。 78 胃腸道功能的監(jiān)護 ? 危重患者出現(xiàn)消化道應(yīng)激性潰瘍的比例較高 ? 不能進食者，除給予全腸道外營養(yǎng)外，盡早予腸道內(nèi)營養(yǎng) 79 腦功能的監(jiān)護 ? 重癥監(jiān)護治療的目的是通過保證正常的動脈血氧含量及維持腦灌注壓在 70mmHg以上，以免產(chǎn)生繼發(fā)性損害，并使大腦獲得最佳的氧合。 ? Glasgow昏迷評分標準，顱內(nèi)壓監(jiān)測，頸靜脈球部氧飽和度、腦組織氧合壓監(jiān)測，腦多普勒超聲，腦電圖。 80 神經(jīng)系統(tǒng)重癥監(jiān)護治療 ? 應(yīng)保護氣道通暢，常用的措施是氣管內(nèi)插管或氣管切開，必要時用機械通氣維持正常的氣體交換。 ? 控制顱內(nèi)壓和腦灌注壓 ? 抗驚厥治療等 81 凝血功能的監(jiān)護 ? 對臨床上出現(xiàn)：嚴重或多發(fā)性出血傾向；不易用原發(fā)病解釋的微循環(huán)衰竭或休克；多發(fā)性微循環(huán)栓塞的癥狀和體征，如廣泛性皮膚、粘膜栓塞、灶性缺血性壞死、脫落及潰瘍形成，或伴有早期的不明原因的肺、腎、腦等臟器功能不全；抗凝治療有效等情況，要注意是否有 DIC的可能。 82 營養(yǎng)檢測和支持 ? 危重癥患者營養(yǎng)支持目的在于供給細胞代謝所需要的能量與營養(yǎng)底物，維持組織器官結(jié)構(gòu)與功能； ? 通過營養(yǎng)素的藥理作用調(diào)理代謝紊亂，調(diào)節(jié)免疫功能，增強機體抗病能力，從而影響疾病的發(fā)展與轉(zhuǎn)歸，這是實現(xiàn)重癥患者營養(yǎng)支持的總目標。 83 General Principles of Critical Care 84 Early Identification of Problems ? Critically ill patients are at high risk for developing plications ? ICU practitioner must remain alert to early manifestations of an system dysfunction, plications of therapy, potential drug interactions, and other premonitory data ? Early identifying and acting on new problems demands frequent and regular review of all information available 85 86 87 Effective Use of the ProblemOriented Medical Record ? The special importance of finding, tracking, and being aware of ICU issues demands an effective problemoriented medical record. ? In order to define and follow problems effectively, each problem should be reviewed regularly and characterized at its current state of understanding. 88 Monitoring amp。 Data Display ? Efforts should be made to find the most effective and efficient ways of displaying tremendous amount of patient data ? Computerized information systems have the potential for improving patient care in the ICU 89 Supportive amp。 Preventive Care ? Efforts to prevent, treat, or otherwise identify the risks for the plications of diseases and side effects of treatment. ? Integrating evidence based medicine into routine protective practices 90 Attention to Psychosocial amp。 Other Needs of the Patient ? The psychological consequences of critical illness and its treatment have a profound impact on patient oute ? the ICU environment (noise) do potential harm to patients and caregivers. ? Sleep disruption 91 Understand the Limits of Critical Care ? Admission criteria should be reviewed regularly by the medical staff. ? Similarly, ongoing resource utilization efforts should be directed at determining which types of patients are best served by continued ICU care. 92 9
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