中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2011年
3期
244-248
,共5页
严重脓毒症%脓毒性休克%治疗流程%病死率%重症感染
嚴重膿毒癥%膿毒性休剋%治療流程%病死率%重癥感染
엄중농독증%농독성휴극%치료류정%병사솔%중증감염
Severe sepsis%Septic shock%Therapy strategy%Mortality%Severe infection
目的 研究强制性脓毒症治疗流程对严重脓毒症和脓毒性休克患者预后的影响.方法 前瞻性研究2008年6月至2009年12月就诊于两个三级教学医院急诊科的严重脓毒症及脓毒性休克患者195例;应用拯救脓毒症运动标准数据库(SSC database)研究脓毒症患者临床的特点、治疗和预后.纳人标准:符合SSC database诊断标准.2008年6月至12月就诊患者进行现况调查,依据临床医师经验治疗,为对照组.2009年1月至12月间就诊患者采用强制性脓毒症治疗流程治疗,即治疗组.比较强制性脓毒症治疗流程实施前后两组住院病死率.采用SPSS 15.0软件进行数据分析.组间比较采用独立样本t检验.计数资料以率和构成比表示,采用χ2检验.用Kaplan-Meier进行生存曲线分析,以P＜0.05为差异具有统计学意义.结果 治疗组[98.3%(115/117)]与对照组[2.56%(2/78)]比较显著提高血乳酸的检测率(P＜0.01);治疗组69.2%(81/117)患者可以在来诊3 h内给予抗生素,对照组为35.8%(28/78)(P＜0.01);治疗组[47.9%(56/117)]与对照组[25.6%(20/78)]比较显著增加抗生素应用前血培养送检率(P=0.003);治疗组[80.3%(53/66)]与对照组[27%(10/37)]比较显著增加标准液体复苏率,P＜0.01;治疗组[8.1%(3/37)]与对照组[27.3%(18/66)]比较中心静脉压达标率增加(P=0.023);治疗组[29.1%(34/117)]与对照组[44.8%(35/78)]比较住院病死率显著下降(P=0.032).结论 强制性实施脓毒症治疗流程提高了严重脓毒症和脓毒性休克标准治疗依从性,住院病死率下降15.7%.
目的 研究彊製性膿毒癥治療流程對嚴重膿毒癥和膿毒性休剋患者預後的影響.方法 前瞻性研究2008年6月至2009年12月就診于兩箇三級教學醫院急診科的嚴重膿毒癥及膿毒性休剋患者195例;應用拯救膿毒癥運動標準數據庫(SSC database)研究膿毒癥患者臨床的特點、治療和預後.納人標準:符閤SSC database診斷標準.2008年6月至12月就診患者進行現況調查,依據臨床醫師經驗治療,為對照組.2009年1月至12月間就診患者採用彊製性膿毒癥治療流程治療,即治療組.比較彊製性膿毒癥治療流程實施前後兩組住院病死率.採用SPSS 15.0軟件進行數據分析.組間比較採用獨立樣本t檢驗.計數資料以率和構成比錶示,採用χ2檢驗.用Kaplan-Meier進行生存麯線分析,以P＜0.05為差異具有統計學意義.結果 治療組[98.3%(115/117)]與對照組[2.56%(2/78)]比較顯著提高血乳痠的檢測率(P＜0.01);治療組69.2%(81/117)患者可以在來診3 h內給予抗生素,對照組為35.8%(28/78)(P＜0.01);治療組[47.9%(56/117)]與對照組[25.6%(20/78)]比較顯著增加抗生素應用前血培養送檢率(P=0.003);治療組[80.3%(53/66)]與對照組[27%(10/37)]比較顯著增加標準液體複囌率,P＜0.01;治療組[8.1%(3/37)]與對照組[27.3%(18/66)]比較中心靜脈壓達標率增加(P=0.023);治療組[29.1%(34/117)]與對照組[44.8%(35/78)]比較住院病死率顯著下降(P=0.032).結論 彊製性實施膿毒癥治療流程提高瞭嚴重膿毒癥和膿毒性休剋標準治療依從性,住院病死率下降15.7%.
목적 연구강제성농독증치료류정대엄중농독증화농독성휴극환자예후적영향.방법 전첨성연구2008년6월지2009년12월취진우량개삼급교학의원급진과적엄중농독증급농독성휴극환자195례;응용증구농독증운동표준수거고(SSC database)연구농독증환자림상적특점、치료화예후.납인표준:부합SSC database진단표준.2008년6월지12월취진환자진행현황조사,의거림상의사경험치료,위대조조.2009년1월지12월간취진환자채용강제성농독증치료류정치료,즉치료조.비교강제성농독증치료류정실시전후량조주원병사솔.채용SPSS 15.0연건진행수거분석.조간비교채용독립양본t검험.계수자료이솔화구성비표시,채용χ2검험.용Kaplan-Meier진행생존곡선분석,이P＜0.05위차이구유통계학의의.결과 치료조[98.3%(115/117)]여대조조[2.56%(2/78)]비교현저제고혈유산적검측솔(P＜0.01);치료조69.2%(81/117)환자가이재래진3 h내급여항생소,대조조위35.8%(28/78)(P＜0.01);치료조[47.9%(56/117)]여대조조[25.6%(20/78)]비교현저증가항생소응용전혈배양송검솔(P=0.003);치료조[80.3%(53/66)]여대조조[27%(10/37)]비교현저증가표준액체복소솔,P＜0.01;치료조[8.1%(3/37)]여대조조[27.3%(18/66)]비교중심정맥압체표솔증가(P=0.023);치료조[29.1%(34/117)]여대조조[44.8%(35/78)]비교주원병사솔현저하강(P=0.032).결론 강제성실시농독증치료류정제고료엄중농독증화농독성휴극표준치료의종성,주원병사솔하강15.7%.
Objective To study the impact of therapy strategy on outcomes of patients suffering from severe sepsis and/or septic shock. Method A total of 195 patients diagnosed as severe sepsis or septic shock were enrolled for prospective study from June 2008 to December 2009. Patient's clinical manifestation,treatments and outcomes were studied by using SSC database. Patients were divided into control group and treatment group. In control group, patients enrolled from June 2008 to December 2008, were treated with conventional medical care In treatment group, patients enrolled from January 2009 to December 2009 were treated with a novel algorithm of mandatory treatment for sepsis In-hospital mortality of two groups was compared. SPSS15.0 software was used for analysis of data. Chi-square test and unpaired t-test were used for comparisons between groups. Results Compared to the control group The need for blood lactate test was significantly grown in treatment group [98.2% (115/117) versus 2.56% (2/78), P ＜ 0.001]. Antibiotics was administered to 69.2% (81/117) patients of treatment group within 3 hours after their arrival at the emergency department compared to 35.8% (28/78) in the control group (P ＜ 0. 001). Blood cultures made before antibiotics given were 47.9% (56/117) in the treatment group compared to the control group 25.6%(20/78), P = 0. 003. The rate of fluid resuscitation was 80.3% (53/66) in the treatment group and 27%(10/37) in the control group, P ＜0.001. The rate of CVP (8 mmHg was 27.3% (18/66) in the treatment group and 8.1% (3/37) in the control group, P = 0. 023. In-hospital mortality was 29.1% (34/117) in the treatment group and 44.8% (35/78) in the control group, P =0. 032. Conclusions The algorithm of mandatory treatment for sepsis improved the therapeutic efficacy of the treatment for severe sepsis and septic shock, decreasing in-hospital mortality.
