中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2012年
8期
478-481
,共4页
张艳芳%李琼芬%陈磊%王毅%魏辉明%钱传云
張豔芳%李瓊芬%陳磊%王毅%魏輝明%錢傳雲
장염방%리경분%진뢰%왕의%위휘명%전전운
早期目标导向治疗%感染性休克%失血性休克%液体管理%病死率
早期目標導嚮治療%感染性休剋%失血性休剋%液體管理%病死率
조기목표도향치료%감염성휴극%실혈성휴극%액체관리%병사솔
Early goal directed therapy%Septic shock%Hemorrhagic shock%Fluid management%Mortality
目的 探讨早期目标导向治疗(EGDT)中液体管理策略对休克患者预后的影响.方法 回顾性分析79例本院急诊重症监护病房( EICU)感染性休克或失血性休克患者的临床资料.按理论计算大概的输液量持续液体复苏,并根据血压、心率、脉搏血氧饱和度( SpO2)及尿量来决定输液速度,复苏终点是自主循环功能恢复、血管活性药物撤离的患者为持续液体复苏组(41例)；在早期给予一定量(20 ml/kg)液体复苏后采用血管活性药物来维持血压的患者为保守液体复苏组(38例),比较2组患者28 d病死率和升压药物使用时间.按28 d预后分为存活组(37例)和死亡组(42例),比较急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分等相关指标,对影响患者预后的因素进行logistic回归分析,确定和描述休克患者的预后与液体复苏方法策略间的关系.结果 持续液体复苏组28d病死率明显低于保守液体复苏组(14.63％比94.74％,P＜0.01),升压药物使用时间(h)明显缩短(33.24±17.56比58.29±34.78,P＜0.05).42例死亡患者中选择保守液体复苏36例(85.7％),37例存活患者中选择持续液体复苏35例(94.6％).Logistic回归分析显示,出ICU或死前的脑钠肽优势比(OR)=0.9136,95％可信区间(95％CI)为(0.8125,0.9986),回归系数-0.0931,P=0.0478;出 ICU或死前降钙素原OR=0.9095,95％ CI为(0.8294,0.9973),回归系数-0.0949,P=0.0436;出ICU或死前血乳酸OR=0.5023,95％CI为(0.2833,0.8905),回归系数-0.6885,P=0.0184.结论 按理论计算输液量早期持续进行液体复苏,并根据患者的血压、心率、SpO2及尿量来决策输液速度,及时撤离血管活性药物的休克患者病死率明显降低.
目的 探討早期目標導嚮治療(EGDT)中液體管理策略對休剋患者預後的影響.方法 迴顧性分析79例本院急診重癥鑑護病房( EICU)感染性休剋或失血性休剋患者的臨床資料.按理論計算大概的輸液量持續液體複囌,併根據血壓、心率、脈搏血氧飽和度( SpO2)及尿量來決定輸液速度,複囌終點是自主循環功能恢複、血管活性藥物撤離的患者為持續液體複囌組(41例)；在早期給予一定量(20 ml/kg)液體複囌後採用血管活性藥物來維持血壓的患者為保守液體複囌組(38例),比較2組患者28 d病死率和升壓藥物使用時間.按28 d預後分為存活組(37例)和死亡組(42例),比較急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分等相關指標,對影響患者預後的因素進行logistic迴歸分析,確定和描述休剋患者的預後與液體複囌方法策略間的關繫.結果 持續液體複囌組28d病死率明顯低于保守液體複囌組(14.63％比94.74％,P＜0.01),升壓藥物使用時間(h)明顯縮短(33.24±17.56比58.29±34.78,P＜0.05).42例死亡患者中選擇保守液體複囌36例(85.7％),37例存活患者中選擇持續液體複囌35例(94.6％).Logistic迴歸分析顯示,齣ICU或死前的腦鈉肽優勢比(OR)=0.9136,95％可信區間(95％CI)為(0.8125,0.9986),迴歸繫數-0.0931,P=0.0478;齣 ICU或死前降鈣素原OR=0.9095,95％ CI為(0.8294,0.9973),迴歸繫數-0.0949,P=0.0436;齣ICU或死前血乳痠OR=0.5023,95％CI為(0.2833,0.8905),迴歸繫數-0.6885,P=0.0184.結論 按理論計算輸液量早期持續進行液體複囌,併根據患者的血壓、心率、SpO2及尿量來決策輸液速度,及時撤離血管活性藥物的休剋患者病死率明顯降低.
목적 탐토조기목표도향치료(EGDT)중액체관리책략대휴극환자예후적영향.방법 회고성분석79례본원급진중증감호병방( EICU)감염성휴극혹실혈성휴극환자적림상자료.안이론계산대개적수액량지속액체복소,병근거혈압、심솔、맥박혈양포화도( SpO2)급뇨량래결정수액속도,복소종점시자주순배공능회복、혈관활성약물철리적환자위지속액체복소조(41례)；재조기급여일정량(20 ml/kg)액체복소후채용혈관활성약물래유지혈압적환자위보수액체복소조(38례),비교2조환자28 d병사솔화승압약물사용시간.안28 d예후분위존활조(37례)화사망조(42례),비교급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분등상관지표,대영향환자예후적인소진행logistic회귀분석,학정화묘술휴극환자적예후여액체복소방법책략간적관계.결과 지속액체복소조28d병사솔명현저우보수액체복소조(14.63％비94.74％,P＜0.01),승압약물사용시간(h)명현축단(33.24±17.56비58.29±34.78,P＜0.05).42례사망환자중선택보수액체복소36례(85.7％),37례존활환자중선택지속액체복소35례(94.6％).Logistic회귀분석현시,출ICU혹사전적뇌납태우세비(OR)=0.9136,95％가신구간(95％CI)위(0.8125,0.9986),회귀계수-0.0931,P=0.0478;출 ICU혹사전강개소원OR=0.9095,95％ CI위(0.8294,0.9973),회귀계수-0.0949,P=0.0436;출ICU혹사전혈유산OR=0.5023,95％CI위(0.2833,0.8905),회귀계수-0.6885,P=0.0184.결론 안이론계산수액량조기지속진행액체복소,병근거환자적혈압、심솔、SpO2급뇨량래결책수액속도,급시철리혈관활성약물적휴극환자병사솔명현강저.
Objective To evaluate the effects of fluid management strategies in early goal directed therapy (EGDT) on the prognosis of patients with shock.Methods Clinical data of 79 patients with septic shock or hemorrhagic shock admitted to emergency intensive care unit ( EICU ) of the First People's Hospital of Yunnan Province were retrospectively analyzed.Patients were divided into continual fluid administrating group (n =41 ) in accordance with protocol calculating approximating fluid volume and adjust the infusion speed based on blood pressure,heart rate,pulse saturation of blood oxygen (SpO2) and urine output with the end of fluid resuscitation was set to restore spontaneous circulation function and wean off vasoactive drugs,and the conservative fluid resuscitation group ( n=38 ) by means of using vasoactive agents to maintenance blood pressure after infusing amount ( 20 ml/kg ) of liquid early,respectively.The 28-day mortality and the time of using pressure agents were compared between two groups.According to the 28-day mortality,patients were further divided into the survival group ( n=37 ) and death group ( n=42 ),and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) score was compared between two groups.Logistic regression analysis of prognostic factors was conducted to identify and describe the relationship between the prognosis and fluid resuscitation methods and strategies.Results The 28-day mortality of continual fluid administrating group was significantly lower than thai of the conservative fluid resuscitation group (14.63％ vs.94.74％,P＜0.01 ),total drugs supporting time ( hours ) was significantly shorter than that in conservative fluid resuscitation group ( 33.24 ± 17.56vs.58.29 ± 34.78,P＜0.05 ).Thirty-six cases of 42 death patients received conservative fluid resuscitation (85.7％),but 35 cases of 37 survival patients received continual fluid administration ( 94.6％ ).Logistic regression analvsis showed that odds ratio ( OR ) of brain natriuretic peptide before death or shifted out ICU was 0.9136,95％ confidence interval (95％CI) was 0.8125 to 0.9986,regression coefficient was-0.0931,P=0.0478,OR of procalcitonin before death or shifted out ICU was 0.9095,95％CI was 0.8294 to 0.9973,regression coefficient was-0.0949,P=0.0436,and OR of blood lactate level before death or shifted out ICU was 0.5023,95％CI was 0.2833 to 0.8905,regression coefficient was -0.6885,P=0.0184.Conclusion Ongoing fluid resuscitation early in accordance with method to theoretically calculate fluid volume and to adjust infusion speed based on blood pressure,heart rate,SpO2 and urine,withdrawal of vasoactive drugs,the mortality of patients with shock was significantly reduced.
