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1、危重病相关皮质醇不足的诊断和管理指南在2008年成人和儿患者危重病相关皮质醇不足(critical illness-related corticosteroid insufficiency, CIRCI )诊断和管理共识基础 上，2018年1月和4月在Crit Care Med和Intensive Care Med上正式发表 了2017SCCM和ESICM :危重病相关皮质醇不足的诊断和管理指南，分 I、 II两部分。一、CIRCI的症状和体征01常见症状发热，乏力(asthenia )神经系统意识模糊谵妄昏迷心血管液体复苏仍然顽固性低血压对儿茶酚按敏感性下降心指数升高消化道恶心呕吐肠内营养不
2、耐受sI竦亢驯亩亩念 度 目 昌 昌rHJt-Hr*hgs-m田娜-0-fi跚3ffIII，CIRCI IsrIs -osr- cortisoresponse i。synihfDfs,adrfDnocortiAOsrops,hormone (ACTH; cosynstopin) superior-。random pnsma or serum &taooasof。二 he d,g，nosis of CIR9 RecommendafiomThefaskforce makes 50 SAO33A3 daMonregarding whetherf。use deMa cortiso(changebase
3、=ne cortisoa- 60 minof 人 9 l-lgdD after cosynsropin (250 Kg) adminissraMon or a random porsmacortisoof 人 10 Kg、d- for -he diagnosis of CIRCLA9 ug、d-)景fflsmMAS?。ug、d- s CIRQ、Hsss2 Is pfirsma 2- serum free cortisomve- superior fopQrsma asr- cortisoove- for fhe diagnosis of CIR9Recommendation: We sugge
4、st again%uSQ.ng pfirsma freecortisomve-rafher fhan pQrsma sn- cortisofor -he diagnosis of CIRCIaondMiona- recommendafioaveryow qua-ity of evidence)*CIRQ2Z 费mKZHW6E00T0S)qluostouOIPAq Qsuodsal EulfQUAPOUlQq 0114 W04 covra3Ewxb 6TI.0SZ 。QMS %66nsQMu.2(QpuQluEOU0a!ZI 睫 Iu。SMOU6.SPQqotsQu.22nul43s ZHW 6
5、I1.0SZQqko0asw3E oom OS)oUOSPJOuOJPAqasuodsaluulfoUAPOluoq si .s(3i、) su iKH H.D( 6n，I) (6n,0sz ) HISSW - Z 费 ZHW 6noszfr着Mwwu fiBsl ZHW 6n，IEQ(.b.宙 UUQP5QM-。a=CQnb Moco寻rapuQIululoual5uopuou) IU&IUM-OSWOU6.2PQqpQsnQqsa)2 Covra-SEVW ZHW (6TNI-I)QSOPMO- uQqQl(Qx6rl osz) dsopq6q 4*(Qln 院066nsQMu。事rapu
6、0Eluou0aIBu。SWOU6.2P 。%q4*hi-u6I10szQq。.2QdnstsQCOVQ-3EVM ZHW0)M-。a=fQnb Mo咨olcowfQpuQululoual5s 6.Esn 3su6tQ%066nsQMeuoArapuQluEOUQa!B3M-o SMOU6.SP05。oAvostou -3tQlus5s 涉m推荐：建议采用250-ug ACTH 刺激SffiCIRCI,而不是采用血流动力学对氢化可 的松(50-300 mg )的反应性(有条件推荐，非常低质量证据)6. Is corticotropin level superior to the 250-pg
7、ACTHstimulation test for the diagnosis of CIRCI?Recommendation: We suggest against using corticotro - pinlevels for the routine diagnosis of CIRCI (conditional recommendation, lowquality of evidence).6.采用促皮质素水平诊断CIRCI是否优于250-ug ACTH剌激试验？推荐：建议不应采用促皮质素水平作为常规诊断CIRCI的方案(有条件推荐，低质量证 据)三、危重病情况下使用皮质醇的推荐意见1、
8、SepsisA. Should corticosteroids be administered among hos-pitalized adult patients with sepsis without shock?Recommendation: We suggest against corticoster- oidadministration in adult patients with sepsis without shock (conditionalrecommendation, moderate quality of evidence).B. Should corticosteroi
9、ds be administered among hospi-talized adult patients with septic shock?Recommendation: We suggest using corticosteroids inpatients with septic shock that is not responsive to fluid and moderate- tohigh-dose vasopressor therapy (condi- tional recommendation, low quality ofevidence).C. What is the re
10、commended dose and duration of treat-ment among hospitalized adult patients with septic shock treated withcorticosteroids?Recommendation: If using corticosteroids for septicshock, we suggest using long course and low dose (e.g., IV hydrocortisone400 mg/day for at 23 days at full dose) rather than hi
11、gh dose and shortcourse in adult patients with septic shock (conditional recommendation, lowquality of evidence).1. 脓毒症A.不合并休克的脓毒症成人住院患者是否可以给予皮质醇？推荐：对于不合并休克的脓毒症成人患者，建议不要使用皮质醇（有条件推荐，中等质 量证据）B.脓毒性休克住院成人患者是否应该给予皮质醇？推荐：对液体和中-高-剂量升压药物无反应的脓毒性休克患者，建议给予皮质醇（有条 件推荐，低质量证据）.对于住院成人脓毒性休克患者，使用皮质醇的剂量和持续时间是多少？推荐：如果使
12、用皮质醇治疗成人脓毒性休克，建议采用长程和低剂量（比如，2氢化 可的松=3天）而不是高剂量和短程皮质醇（有条件推荐，低质量 证据）2、Acute respiratory distress syndromeShould corticosteroids be administered among hos-pitalized adult patients with acute respiratory distress syndrome?Recommendation: We suggest use of corticosteroids inpatients with early moderate to
13、 severe acute respira- tory distress syndrome（PaO /FiO of 200 and within 14 days of onset） （conditional recommendation,moder- ate quality of evidence）.2. 急性呼吸窘迫综合征住院成人急性呼吸窘迫综合征患者是否给予皮质醇？推荐：建议皮质醇可以用于早期中-重度急性呼I吸窘追综合征（PaO2/FiO2200，发病14天内）（有条件推荐，中等治疗证据）3、Major traumaShould corticosteroids be administere
14、d among hospital-ized adult patients with major trauma?Recommendation: We suggest against the use of cor-ticosteroids in major trauma （conditional recommenda- tion, low quality ofevidence）.3. 严重创伤4，community.acquired pneumoniashoEd corticosteroids be administered ff hospMa 一N*edaduws wMh communityacqE.redpneumonia (CA32Recommendafiom We suggest -he c$ of cortkosieToidsfor 517 days af m dai一y dose 人
