As a serious phase of sepsis, the degree of risk and the high rate of death are serious challenges in the field of critical medical care. It is important to improve patient prognosis, reduce disease and death rates and provide timely and effective treatment.
The first stage of septic shock treatment is liquid resuscitation. The rapid and adequate refilling of liquids during the early days of shock has allowed for the expansion of effective circulatory blood levels, which is a crucial point.
Crystall fluids such as physicosal water and lactation liquefie are often preferred, and can be quickly distributed to extracellular fluids, supplementing the loss of liquids within the veins and interlocking. Rubber fluids, such as protein, may also be used on a patient-by-patient basis, having the advantage of maintaining plasma pneumatic pressure and helping to reduce the leakage of liquids to the inter-organizational gap.
However, when the liquid is resuscitated, there is a need to closely monitor the patient ‘ s mobility mechanics indicators, such as central intravenous pressure (CVP), average arterial pressure (MAP), urine, etc., to avoid complications such as excessive heart and lung failure. The target-oriented treatment strategy emphasizes the dynamic adjustment of the rate and volume of the infusion to these indicators to maintain CVP in the 8-12 mm column of mercury, MAP above 65 ~70 mm of mercury, with urine not less than 0.5 mm/kg per hour for tissue refilling purposes.
Angiologically active drugs are essential for application in septic shock treatment. Angularly active drugs need to be activated in a timely manner when liquid resuscitation fails to fully improve the blood pressure and tissue injection of the patient. Adrenalin is a first-line drug, which increases blood pressure mainly by constricting the blood vessels and increasing the outer perimeter resistance, while having a relatively small impact on the heart rate, which ensures the function of the heart while improving the pressure. Dopamine has also been widely used, but in view of its high incidence of adverse events, such as heart disorders, its status in sepsis treatment has gradually been replaced by deadrenalin. Angiogens can be used as an assistive drug in combination with adrenalin, which can help significantly in reducing the use of adrenalin, with associated side effects. During the use of vascularly active drugs, changes in blood pressure are continuously monitored and the dose of the drug is adjusted to the blood pressure in order to maintain it within the target range.
Anti-infection treatment is at the heart of septic shock treatment. The relevant specimens should be taken for pathogen testing at the first time after diagnosis, followed immediately by broad-scale, highly effective antibiotic treatment on an empirical basis. The choice of antibiotics needs to take into account factors such as the age of the patient, the underlying disease, the area of infection, local epidemiological data, etc., to ensure coverage of potential pathogenic microorganisms. When pathogen results are obtained, in order to reduce the abuse of antibiotics and to produce resistant bacteria, they should be adapted in a timely manner to target narrow spectra antigens.
At the same time, the course of treatment for the use of antibiotics should be determined on the basis of the individualisation of the patient ‘ s condition, the severity of the infection and the treatment response, generally for 7 to 10 days, but may need to be extended as appropriate in the case of specific pathogen infections or in cases where it is difficult to remove them.
In addition, controversy over the application of sugar cortex hormones to septic shock has persisted. Short-range, small-dose use of sugar cortex hormones, such as pines, which are hydrogenized, could be considered, and patients who are still having difficulty in maintaining serodynamic stability through full liquid resuscitation and vascular activity therapy. Its mechanisms of action may be to contain inflammation reactions, stabilize cellular membranes, improve the reactivity of blood vessels to vascular active substances, etc. However, the occurrence of complications such as blood sugar and infections requires close monitoring during use.
Support for organ function is also important for septic shock treatment. For a combination of acute respiratory distress syndrome (ARDS), the use of a pulmonary protective respiration strategy such as a small tidal volume (6-8ml/kg) and an appropriate pneumatic pneumatic pressure (PEEP) to reduce the correlation of lung damage on the respirator may require mechanical respiration support. In cases of acute kidney damage, kidney substitution therapy (CRRT) is performed in a timely manner that helps to remove the toxin from the body, maintain hydrolysis and acid alkali balance, and stabilize the internal environment. Attention must also be paid to the coagulation function, gastrointestinal function, etc. of the patient, and appropriate support and protection measures such as the prevention of stress ulcer and the correction of condensation abnormalities.
In sum, the treatment of sepsis is a multi-dimensional, systematic project requiring close collaboration among multidisciplinary teams, such as the medical, infectious and microbiology departments. From liquid resuscitation, the application of vascularly active drugs, anti-infection treatment to organ function support, there is a need for precision and dynamic adaptation to the specific circumstances of the patient in order to improve the survival of the patient while the long-term prognosis improves.
As medical research continues, it is believed that more breakthroughs and progress will be made in the future in the area of septic shock treatment.
A sepsis. A septic shock.
