外總-p外科全身性感染

InfectionPresence

of anism

in

normally

sterilesite panied

by

an

inflammatory

hostresponse病源微生物+宿主炎性反應(yīng)Systemic

InflammatoryResponse

Syndrome(SIRS)全身炎癥反應(yīng)綜合征systemic

inflammatory

response

withoutevidence

of

infection全身炎癥反應(yīng)+無(wú)的依據(jù)體溫、心率、呼吸、白細(xì)胞計(jì)數(shù)Systemic

InflammatoryResponse

Syndrome全身炎癥反應(yīng)綜合征Being

manifested

by

at

least

2

followings:T>38℃

or

T<36

℃HR

>90

bpmRR

>20

bpm

or

PaCO2

<32mmHgWBC

>12000

or

<4000A

systemic

host

response

similar

to

sepsisThe

trigger

for

tissue

injury

is

notbacterial

toxins

but

massive

trauma

suchas

mechanical

injury

or

burnsSystemic

InflammatoryResponse

Syndrome全身炎癥反應(yīng)綜合征促炎癥反應(yīng)抗炎癥反應(yīng)TNF,IL-1,IFN,LTIL-2,IL8,IL-12,IL-18,LTB4,GM-CSF,Chemokines,MIFIL-1ra,

sTNFR,sIL-1RTGF,IL-4,IL-6,IL-10IL-11,IL13,PGE2,G

-CSFantioxidants,IFN/Bacteremia菌血癥Positive

blood

culture

of

bacteria

withoutsystemic

inflammatory

response血培養(yǎng)陽(yáng)性+無(wú)全身炎癥反應(yīng)Sepsis膿毒癥Clinical

evidence

of

infection

&

systemicresponse

to

infection臨床

的依據(jù)+全身炎癥反應(yīng)Sepsis

syndrome膿毒綜合征Sepsis

with

hypoxia,

elevated

lactate,oliguria,

altered

mental

status膿毒癥+

灌注不足（缺氧、高乳酸血癥、無(wú)尿、精神癥狀）膿毒癥的病因Causes

of

SepsisSevertrauma（嚴(yán)重

）Severe

burn（嚴(yán)重?zé)齻〢cute

Obstructive

Suppurative

Cholangitis（急性化膿性膽管炎）Acute

diffused

peritonitis（急性彌漫性腹膜炎）Catheter-related

infection（靜脈導(dǎo)管

）Gut

derived

infection（腸原 染）膿毒癥的高危因素?Risks

Factors

ofSepsispromised

patients（免疫力低下）More

frequent

use

of

invasive

devices

orprocedure（反復(fù)有創(chuàng)性操作）Greater

availability

of

life-sustaining

technologyHigher

frequency

ofinfections

caused

by

resistantanisms（反復(fù)耐藥菌株

）Aging

population（老年人）膿毒癥的分布Distribution

of

Sepsis革蘭氏染色細(xì)菌膿毒癥——57%（Gram-Negative

Sepsis)革蘭氏染色陽(yáng)性細(xì)菌膿毒癥——40%（Gram-Positive

Sepsis）真菌性膿毒癥——3%（Fungi

Sepsis）膿毒癥的臨床表現(xiàn)Signs

&

Symptoms

of

SepsisPrimaryFever（發(fā)熱）Chills（寒戰(zhàn)）Hyperventilation（呼吸急促）Skin

lesions（皮損）Change

in

mental

status（精神狀態(tài)改變）膿毒癥的臨床表現(xiàn)Signs

& Symptoms

of

SepsisComplicationHypotension（低血壓）Bleeding

&

Leukopenia

&

Thrombocytopenia(

、白細(xì)胞減少、血小板減少）Cyanosis

&

Acidosis（ 、酸

）Oliguia

&

Anuria（少尿、無(wú)尿）Congestive

failure（心功能衰竭）Jaundice（黃疸）革蘭氏

桿菌膿毒癥的病原菌Bacteria

of

Gram-negative

SepsisFrequencyMortaliyE.Coli（大腸桿菌）Pseudomonas

（假單胞菌）Klebsiella（克雷白菌）Klebsiella（克雷白菌）Pseudomonas（假單胞菌）Proteus

（變形桿菌）Serratia（ 菌）E.Coli

（大腸桿菌）Enterobacter（腸桿菌）Serratia

（ 菌）Proteus（變形桿菌）Enterobacter

（腸桿菌）Gram-negative

sepsisEndotoxinG(+)

sepsisG(-)

sepsisbacteriaS.aureusE.ColiPseudomonastoxinexotoxinendotoxinPrimarysitescarbuncle,cellulitis,

burnbiliary,

uriary,GI,

burnchillseldomcommonfeverlasting

highhighor

lowskin

lesioncommonseldomchanges

in

CNScommonseldomHypoxia

&CyanosisseldomcommonoliguriaseldomcommonshockseldomcommonSecondary

myocarditiscommonseldomsecondary

abscesscommonseldom真菌性膿毒癥的特點(diǎn)Characteristics

of

Fungal

Sepsis條件

染/二重（The

result

of

opportunistic

infection

after

broad-spectrum

antibiotics

therapy）白色念珠菌（Candida

albicans

is

the

commonestpathogen）酷似革蘭氏

桿菌膿毒癥（Chill,

fever>39.5℃,

change

in

mental

status,hypotension,

shock）白血病樣反應(yīng)（WBC>25,000/dl，晚幼粒、中幼粒）膿毒癥的預(yù)后和

率Mortality

&

Prognosis

of

SepsisClinical

signs（臨床表現(xiàn)）Mortality

rate（

率）Fever,Leukocytosis（發(fā)熱、白細(xì)胞升高）10%Multiple an

Failure（多臟器衰竭）64%Shock（休克）69%Shock

with

MOF（休克+多臟器衰竭）88%Total42%膿毒癥的治療Treatment

of

SepsisDebridement

of

primary

infection（去除灶）Antibiotics

therapy（合理應(yīng)用抗生素）Supportive

&

Miscellaneous

Therapy（支持和綜合治療）膿毒癥的支持和綜合治療Supportive

&

Miscellaneous

TherapyRecovery

of

enteral

nutrition

as

possib