????? Critical care medicine ??? ? ?

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?????Critical care medicine??? ? ?

• ????????????????
• ??ICU
• ???
• 2006.5.20

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? ?

• ????????????(shock unit)
• 20??50???,??????????????
• ICU??---1958??????????????????????ICU
• 20??60???,????????????????????????????????????????
  ?---?????(critical care medicine)???????
• 1970?????????????
• 2005?3?????????????????

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?????Critical care medicine

• ????
• ??????????????
• ?????

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????????

• ???????????????
• 1.?? ??????
• 2.????? ????????
• 3.???(anesthesiology)???????? (anesthesia and
  critical care) ????????
• ??????(department of anesthesiology and
  resuscitation)
• ????????(department of anesthesia and critical
  care)

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?????????

• ??????????????????????????????????????????????????
  ?????????
• ???????????????????????????????????????????????
• ????????????

6
?????????

• ????(common path)?????
• ????????????????????????
• ??????

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????

• 1.????????????,??????????????????????????
• 2.???????????????
• 3.????????????
• 4.???????????????
• 5.??????

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?????

• ?????(critical care medicine CCM)????????????????
  ??????,?????????????
• CCM??????????????
• ???CCM???????????

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????

• ????(emergency medicine EM)
• ??????????,???????????????,????????????
  ???????????,???????????????????????????????????
• ????????????????(first aid),?????????????????????
• ????(disaster medicine,DM)???????????????

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??

• ??(resuscitation) ??????????????????????????????
• ????(cardiopulmonary resuscitation,CPR)
• ?????(cardiopulmonary cerebral resuscitation,CPCR)
  

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• CPCR????????
• (1)??????(basic life support,BLS)
• (2)??????(advanced life support,BLS)
• (3)??????(prolonged life support,PLS)

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??????

• ??????(intensive care unit ICU)
• ?????????????,??????????????????????,?
  ?????????????,??????????

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ICU???

• (1)???????
• (2)????????????????????????,??????????????
• (3)?????????
• (4)ICU?????????????
• (5)?????????
• (6)??????????????????
• ??,ICU??????????????,????????????

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??? ???????

• ???????(general body response to trauma
  ),?????????(stress response to trauma)???????????
  ????????????????????????????????????
• ??????????(systemic inflammatory response
  syndrome,SIRS)
• ??????????(compensatory anti-inflammatory
  response syndrome,CARS )
• SIRS??CARS

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(No Transcript)
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???????
???????

• ??-???????
• ????????,?????????
• (1)HR?,CO?,BP?,???????
• (2)???????????????????????
• (3)RR?,TV?,???
• (4)?????????,???,????????,???????????????
• (5)??????????(adrenocorticotropin,ACTH)???????????
  ?????????????????,????????

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???????
???????

• ???-??-???????
• ??????????,????????????????????,?????
• (1)?????????,????,???????????????
• (2)?????????
• (3)??????????,????????
• (4)??????,?????????
• (5)?????????,??????,??????
• (6)???????????,??????????

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???????
???????

• ????
• 1.????(growth hormone)
• 2.?????(antidiuretic hormone)
• 3.ß-???
• 4.???? ????????(thyroid stimulating hormone)
• 5.?????????
• 6.??-?????-?????

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???????
???????

• ??????????(systemic inflammatory response
  syndrome,SIRS)
• ??????????(multiple organ dysfunction
  syndrome,MODS)

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???????
???????

• ????????
• (1)??????
• (2)?????A2
• (3)????-????

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???????
???????

• ??????????
• ????????????????????????????,?????????????????(com
  pensatory anti-inflammatory response
  syndrome,CARS )
• SIRS??CARS

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???????
???????

• ??????DIC(disseminated intravascular coagulation)

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???????
???????

• ??????
• ??
• ??

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???????
???????

• ??????RR?,TV?,???????????
• ARDS

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???????
???????

• ?????
• ?????
• ????

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???????
???????

• ?????,
• ???????(ARF)

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?????????
???????

• ????????????(posttraumatic stress disorder,PTSD)
• ICU??

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?????????
???????

• ?????????????(posttraumatic stress disorder,PTSD)
• ICU??
• ICU??

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?????
???????

• ?????????????,????,?????????
• (1)???
• (2)???????????
• (3)??

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???????????
??????????

• HPA???
• ???-??-????(hypothalamic-pituitary-adrenal axis,
  HPA )
• ???????????
• ????????????????

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????????????
??????????

• ?????????
• 1.????????
• 2.?????????
• 3.??????????
• 4.????

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????????????
??????????

•    ?????????
• 1.???????????????????????
• 2.????????????????
• 3.??????????????

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• ?????
• ??100mg qdivgtt
• 0.9Nacl 50ml ???4? qdivgtt
• 5Gs 100ml ???2??R??? qdivgtt
• 5Gs 100ml ???4??R??? qdivgtt
• 5Gs50ml ?R 50?? 1-6ml/h ??????
• 5Gs 100ml ???150mg 10ml/h qdivgtt
• 0.9Nacl 100ml???4.5 Bid ivgtt
• 5GS 100ml??0.5 ??????qdivgtt
• 0.9Nacl 100ml???4? qdivgtt
• 0.9Nacl 100ml???120mg qdivgtt
• 0.9Nacl 50ml??0.25 Bid ivgtt

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• ??? 60mg Bid iv
• 0.9Nacl 80ml??2??? qd ????
• ???2600ml10Nacl 60ml 110ml/h???????
• ???? Q4h(???2ml???5ml)
• ?9? ?? 2.5mg?? 1? Qd ??
• ?9? ??? 50 mg Qd ??
• ???2? Bid ??
• ?????2???????3????1????1? Tid ??
• ???? ???? Q2h
• ???? Q4h
• ???? Qd
• ????????? ?????
• ???? 1? Bid ??
• ???1? Qd ??
• ??10mg Tid ??
• 2004-6-1

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???

• 1.??????????????????
• 2.??????????????????