中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2009年
3期
286-292
,共7页
郭琦%黎毅敏%农凌波%徐远达%何国清%何为群%陈思蓓%刘晓青%李静%江梅%徐永昊%肖正伦%钟南山
郭琦%黎毅敏%農凌波%徐遠達%何國清%何為群%陳思蓓%劉曉青%李靜%江梅%徐永昊%肖正倫%鐘南山
곽기%려의민%농릉파%서원체%하국청%하위군%진사배%류효청%리정%강매%서영호%초정륜%종남산
重症肺炎%感染性休克%集束治疗%病死率
重癥肺炎%感染性休剋%集束治療%病死率
중증폐염%감염성휴극%집속치료%병사솔
Severe pneumonia%Septic shock%Bundles%Mortality
目的 探讨国内严重感染集束治疗的疗效.方法 在广州医学院附属第二医院呼吸重症监护病房中选用43例重症肺炎及感染性休克患者,进行14个月(2006年11月1日至2007年12月31日)前瞻性观察研究.患者入进标准参照2001年国际脓毒症会议.分教育、试验和运作3个连续阶段实施6 h严重感染集束治疗和24 h严重感染集束治疗.历史对照期内(2004年1月1日至2006年10月31日)合格患者门入对照组.计最资料以(x±s)表示,计数资料以率表爪.采用γ2检验、独立样本t榆验、配对t检验、单因素和多冈素Logistic回归分析,P＜0.05为差异具有统计学意义.结果 1)对照组和集束治疗组问的基础特征差异基本上无统计学意义.2)血清乳酸测定率、休克业组液体复苏率及6 h内所输入液体量、血糖榨制,与对照组相比较,其差异均有统计学意义(P值分别是0.024,0.009,0.045和0.000).3)72 h时,集束治疗组呼吸频率和氧合指数,与对照组相比较,其差异均有统计学意义(P值分别是0.033和0.041);集束治疗组中休克业绀急性生理和慢性疾病评分(A-PACHE)Ⅱ分值和预计死亡率的下降值,与对照组中休克业组比较,其差异均有统计学意义(P值分别是0.017和0.040).4)与对照组比较,集束治疗组病死率绝对值下降23.30%(P=0.019).结论 严重感染集束治疗能显著降低重症肺炎及感染性休克患者病死率.
目的 探討國內嚴重感染集束治療的療效.方法 在廣州醫學院附屬第二醫院呼吸重癥鑑護病房中選用43例重癥肺炎及感染性休剋患者,進行14箇月(2006年11月1日至2007年12月31日)前瞻性觀察研究.患者入進標準參照2001年國際膿毒癥會議.分教育、試驗和運作3箇連續階段實施6 h嚴重感染集束治療和24 h嚴重感染集束治療.歷史對照期內(2004年1月1日至2006年10月31日)閤格患者門入對照組.計最資料以(x±s)錶示,計數資料以率錶爪.採用γ2檢驗、獨立樣本t榆驗、配對t檢驗、單因素和多岡素Logistic迴歸分析,P＜0.05為差異具有統計學意義.結果 1)對照組和集束治療組問的基礎特徵差異基本上無統計學意義.2)血清乳痠測定率、休剋業組液體複囌率及6 h內所輸入液體量、血糖榨製,與對照組相比較,其差異均有統計學意義(P值分彆是0.024,0.009,0.045和0.000).3)72 h時,集束治療組呼吸頻率和氧閤指數,與對照組相比較,其差異均有統計學意義(P值分彆是0.033和0.041);集束治療組中休剋業紺急性生理和慢性疾病評分(A-PACHE)Ⅱ分值和預計死亡率的下降值,與對照組中休剋業組比較,其差異均有統計學意義(P值分彆是0.017和0.040).4)與對照組比較,集束治療組病死率絕對值下降23.30%(P=0.019).結論 嚴重感染集束治療能顯著降低重癥肺炎及感染性休剋患者病死率.
목적 탐토국내엄중감염집속치료적료효.방법 재엄주의학원부속제이의원호흡중증감호병방중선용43례중증폐염급감염성휴극환자,진행14개월(2006년11월1일지2007년12월31일)전첨성관찰연구.환자입진표준삼조2001년국제농독증회의.분교육、시험화운작3개련속계단실시6 h엄중감염집속치료화24 h엄중감염집속치료.역사대조기내(2004년1월1일지2006년10월31일)합격환자문입대조조.계최자료이(x±s)표시,계수자료이솔표조.채용γ2검험、독립양본t유험、배대t검험、단인소화다강소Logistic회귀분석,P＜0.05위차이구유통계학의의.결과 1)대조조화집속치료조문적기출특정차이기본상무통계학의의.2)혈청유산측정솔、휴극업조액체복소솔급6 h내소수입액체량、혈당자제,여대조조상비교,기차이균유통계학의의(P치분별시0.024,0.009,0.045화0.000).3)72 h시,집속치료조호흡빈솔화양합지수,여대조조상비교,기차이균유통계학의의(P치분별시0.033화0.041);집속치료조중휴극업감급성생리화만성질병평분(A-PACHE)Ⅱ분치화예계사망솔적하강치,여대조조중휴극업조비교,기차이균유통계학의의(P치분별시0.017화0.040).4)여대조조비교,집속치료조병사솔절대치하강23.30%(P=0.019).결론 엄중감염집속치료능현저강저중증폐염급감염성휴극환자병사솔.
Objective To investigate the effects of sepsis bundles in China.Method An observational study of 43 patients with severe pneumonia and septic shock admitted to the respiratory intertive care unit(1/11/2006-31/12/2007)was carried out.The selection criteria were in accordance with criteria set by International Conference On Sepsis in 2001.Implementation of 6 hours and 24 hours sepsis bundles was divided into 3 continu-ous phases consisting of education,trial,and application phase.A cohort of 43 patients with matched disease his-tory(1/1/2004-31/10/2006)was enrolled as control group.The percentages for categorical variables and mean±SD for continuous variables were reported.Chi-Square test.unpaired Student's t -test.paired-samples t test,univariate and multivariate logistic regression models were used.Statistical significance was defined as P＜0.05.Results There were very little significant differences in basic characteristics of patients between the two groups.Compared with control group,the differences in serrum lactate,fluid resuscitation and fluid volume infused within 6 hours and blood glucose control in shock subgroup were significant(P values were 0.024,0.009,0.045,and 0.000,respectively).Compared with control group,the differences in respiratory rate and oxygenation index of bundles group at 72 hours later were significant(P values were 0.033 and 0.041,respectively).Compared with control group,the differences in APACHE Ⅱ score and predicted mortality in shock subgroup of bundles were sig-nificant(P values were 0.017 and 0.040,respectively).Compared with control group,the reduction in absolute mortality was 23.30% in bundles group(P=0.019).Conclusions Implementation of sepsis bundles con-tributes noticeably to the significant reduction in mortality of patients with severe pneumonia and septic shock.
