降阶梯策略在慢性危重症防治中的作用

Role of de-escalation strategies in the treatment and prevention of chronic critical illness

降阶梯策略就是将危重患者各种复杂、昂贵、高风险但又有效的治疗方法逐渐过渡到简单安全、符合生理但仍然有效的治疗方法。而慢性危重症(慢重症)是指外科危重患者在疾病或手术打击后,进入迁延状态,病情不断反复,甚至加重而长期停留在重症监护病房。导致外科慢重症的因素包括高龄、营养不良、多脏器功能障碍和多重打击。在危重患者的治疗过程中,应始终贯彻降阶梯治疗策略,包括抗生素的合理使用、液体治疗的降阶梯策略(即去复苏)、呼吸机适时撤机、连续性肾脏替代措施的快上快下、肠外+肠内营养支持治疗和适时地停止镇静。

De escalation strategy is the gradual transition of various complex,expensive,high risk but effective treatments for critically ill patients to simple,safe,physiological but still effective ones.Chronic critical illness refers to patients suffering severe disease or surgical hit who later shift into a chronic state of relapse or even aggravation and stay in the intensive care unit for extended period.Risk factors for surgical related chronic critical illness include advanced age,malnutrition,multiple organ dysfunction and multiple hits.During the treatment of critically ill patients,the strategy of de escalation therapy should always be implemented,including rational use of antibiotics,de escalation of liquid therapy(i.e.de resuscitation),timely removal of ventilator,rapid introduction and with drawal of continuous renal replacement measures,parenteral+enteral nutrition support therapy and timely cessation of sedation.