毒血症脓毒血症休克的临床诊治路径1课件.ppt

GRANDEARROYO O MEMORIALSAINTFRANCIS M STJOSEPHSST TOCKTON MERCEDMERCY Y HOSPITALMETHODIST H SESIENASTRO NTACRUZDOMINICANSA RYSRENO STMAR HOSPITALCALIFORNIA H MERCYBAK KERSFIELD GENERALMERCY NGBEACH STMARYLON WOODLANDHEA ALTHCARE DELIMASTROSE E STBER RNARDINE MEMORIALGLENDALE M MARTINSTROSESAN N HOSPITALMARKTWAIN H MEMORIALBAKERSFIELD M PHOENIXSTJOSEPHS ROSCOENORTHRIDGE E S STMARYSSANFR RANCISCO CENTERMARIANMEDICA AL SANJUANMERCY S REGIONALCHANDLER FOLSOMMERCY Y S CENTERSTJOHNSMEDICA AL NEVADASIERRA A STEL LIZABETH HOSPITALFRENCH H GILBERTMERCY Y COM MMUNITYSANBER RNARDINO PLE HOSPITALEASANTVALLEY REDDINGMERCY Y HOSPITALSEQUOIA H SHASTAMERCYMT T CHW Mortality Rate Through 2008 Catholic Healthcare West FY07 Sepsis Mortality Rate by Hospital compared to FY08 Feb YTD 60.0% FY07 CHW M edian 32.3% FY08 CHW M edian 26.6% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Baseline Mortality Rate FY08 Mortality Rate FY07 CHW Median Mortality FY08 CHW Median Mortality Conclusions A national educational effort to promote bundles of care for severe sepsis and septic shock was associated with improved guideline compliance and lower hospital mortality. However, compliance rates were still low, and the improvement in the resuscitation bundle lapsed by 1 year. Networks ? North America ? Europe ? ? ? ? ? ? ? ? ? Colorado California: Sutter Baltimore/D.C. IHI Kansas Puerto Rico Texas (State--wide) Illinois ? Chicago Minnesota ? ? ? ? ? ? ? ? ? United Kingdom Ireland Germany Portugal Spain Netherlands Italy Croatia Poland Latin America ? Minneapolis ? SCCM Collaborative ? East Coast Collab ? ? Brazil ? Chile ? West Coast Collab ? Asia China ? （一）适用对象 严重脓毒症 脓毒性休克 （二）诊断依据 2001年国际脓毒症定义诊断标准 系统性炎症反应综合症(SIRS) 1.体温38oC或36oC 2.心率90次/分 3.呼吸20次/分或PaCO24.3 kPa(32mmHg) 4.白细胞计数12×109/L或4××109/L或不成熟中性粒细胞胞10 脓毒症 有SIRS 有感染证据，且具有SIRS指标两项或两项以上者 （二）诊断依据 2001年国际脓毒症定义诊断标准 严重脓毒症 脓毒症+ 器官功能衰竭 脓毒性休克 症+ 脓毒症+ 循环器官功能衰竭((低血压休克)) 表2 下列任意一项器官功能不全表现 收缩压(SBP)90mmHg或平均动脉压(MAP)65