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題 名 | 敗血症病人早期血流動力支持療法的最新臨床發展=The Current Concept of Early Goal-Directed Hemodynamic Therapy in Septic Patients |
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作 者 | 周志道; 尹彙文; 蔣台舟; 周少鈞; 秦維廉; 劉乂鳴; 徐小安; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 6:3 民93 |
頁 次 | 頁220-233 |
分類號 | 415.27 |
關鍵詞 | 嚴重敗血症; 敗血性休克; 組織缺氧; 血流動力; 中央靜脈血氧飽和度; Severe spesis; Septic shock; Tissure hypoxia; Hemodynamic; Central venous oxygen saturation; |
語 文 | 中文(Chinese) |
中文摘要 | 對於加護病房中病患給予以流血動力的目標為導向積極治療,此治療包括調整前負荷(preload),後負荷(afterload)及收縮力(contractility)來維持氧氣輸送(Oxygen delivery)及氧氣需求(oxygen demand)的平衡,臨床上是有意義且重要。研究報告指出對於嚴重敗血症及敗血性休克病患在發病初期給予目標為導向的治療(Early goal-directed therapy),能有效降低敗血症相關致病率、致死率及降低相關的醫療費用。 敗血症早期病人給予血流動力為目標的治療,在器官產生不可逆的衰竭前,可藉由中央靜脈血氧飽和度(ScvO₂)的測量,及時偵測到潛伏型的全身組織缺氧(global tissue hypoxia),加以積極治療。研究指出正常的血壓、中央靜脈壓及尿量等生理參數並無法反映出潛伏型的全身組織缺氧,因此無法在敗血症發生早期給予病人積極的治療,來避免器官發生不可逆的傷害,導致多重器官衰竭甚至死亡。 在嚴重敗血症或敗血性休克病患,起初6小時的黃金復甦期間,血流動力目標導向的治療包括:1. 積極輸液將中心靜脈壓維持在8-12毫米汞柱;2. 使用升壓劑vasopressor將平均動脈壓維持在65毫米汞柱;3. 每小時每公斤尿量大於0.5毫升;4. 中央靜脈血氧或混合靜脈血氧飽和度在70%以上。若給予輸液及升壓劑治療後仍無法達成以上目標,就必須輸濃縮紅血球使血容比達到30%,或者可同時給予強心劑inotropic使中心靜脈血氧或混合靜脈血氧飽和度達到大於70%的目標。使用含特殊感應器的中央靜脈導管持續偵測中央靜脈血氧飽和度,是敗血症病人早期血流動力支持療法中有效的輔助工具,它可以使臨床醫師及早發現全身病態性的組織缺氧。 |
英文摘要 | The early provision of goal-directed hemodynamic support has been shown to reduce mortality in septic patients. This approach involves adjustment of cardiac preload, afterload and contractility to balance oxygen delivery with oxygen demand. Recent data indicate that early goal-directed therapy (EGDT) produces a statistically significant reduction in sepsis-related mortality and morbidity, and in associated healthcare cost. The purpose of early goal-directed hemodynamic therapy is to detect and treat occult tissue hypoxia before organ damage becomes irreversible. Early assessment on the basis of physical finding, vital signs, central venous pressure and urinary output may fail to detect occult tissue hypoxia, yet ultimately lead to multiple organ failure and death. During the first 6 golden hours of resuscitation of severe sepsis or septic shock, the goal of initial resuscitation should include all of following as one part of a treatment protocol: 1) Central venous pressure: 12-18 mm Hg 2) Mean arterial pressure ≧ 65 mmHg 3) urine output ≧ 0.5 mL/kg/hr 4) Central venous oxygen saturation (ScvO₂) ≧ 70%. This goal was achieved by sequential institution of initial fluid resuscitation, vasopressors then packed red blood cell, and then dobutamine. Monitor ScvO₂ is integral part of early goal-directed hemodynamic therapy and enable the clinicians to detect the pathological low ScvO₂ values. |
本系統中英文摘要資訊取自各篇刊載內容。