中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2009年
4期
423-425
,共3页
嵇朝晖%刘旻%董朝晖%邵学平
嵇朝暉%劉旻%董朝暉%邵學平
혜조휘%류민%동조휘%소학평
脓毒性休克%早期目标导向治疗%序贯性器官衰竭评分%急性生理和慢性健康状况评分Ⅱ%病死率
膿毒性休剋%早期目標導嚮治療%序貫性器官衰竭評分%急性生理和慢性健康狀況評分Ⅱ%病死率
농독성휴극%조기목표도향치료%서관성기관쇠갈평분%급성생리화만성건강상황평분Ⅱ%병사솔
Septic shock%Early goal directed therapy SOFA%APACHE Ⅱ%Mortality rate
目的 探讨早期目标导向治疗(EGDT)对脓毒性休克的治疗效果及影响因素.方法 将126例脓毒性休克患者分为治疗组(n=62)和对照组(n=64),治疗组给予EGDT治疗,对照组按传统方法进行循环与容量支持,比较两组治疗前与治疗24 h后序贯性器官衰竭评分(SOFA),急性生理和慢性健康状况(APACHEⅡ)评分及28 d病死率.在治疗组中按复苏6 h后是否达到复苏目标分为达标组(n=40)和未达标组(n=22),比较两组复苏前年龄、性别、相关血流动力学指标、SOFA评分、APACHE Ⅱ评分、血乳酸水平、28 d病死率.结果 治疗组和对照组治疗前两项评分SOFA:(12.26±4.37)vs.(12.54±5.21);KPACHE Ⅱ:(21.26±6.03)vs.(21.64±6.80);差异无统计学意义(P＞0.05),而治疗组治疗24 h后两项评分SOFA:(9.18±3.63)vs.(10.62±4.27);APACHEⅡ:(14.92±3.81)vs.(18.21±4.25);P＜0.05及28 d病死率48.39%vs.76.56%,P＜0.05)明显低于对照组.治疗达标组在年龄、平均动脉压(MAP)和APACHEⅡ评分七与未达标组差异有统计学意义,达标组28d病死率明显低于未达标组.结论 EGDT可明显改善脓毒性休克患者的预后,而年龄、复苏前MAP和APACHEⅡ评分是影响EGDT治疗效果的因素.
目的 探討早期目標導嚮治療(EGDT)對膿毒性休剋的治療效果及影響因素.方法 將126例膿毒性休剋患者分為治療組(n=62)和對照組(n=64),治療組給予EGDT治療,對照組按傳統方法進行循環與容量支持,比較兩組治療前與治療24 h後序貫性器官衰竭評分(SOFA),急性生理和慢性健康狀況(APACHEⅡ)評分及28 d病死率.在治療組中按複囌6 h後是否達到複囌目標分為達標組(n=40)和未達標組(n=22),比較兩組複囌前年齡、性彆、相關血流動力學指標、SOFA評分、APACHE Ⅱ評分、血乳痠水平、28 d病死率.結果 治療組和對照組治療前兩項評分SOFA:(12.26±4.37)vs.(12.54±5.21);KPACHE Ⅱ:(21.26±6.03)vs.(21.64±6.80);差異無統計學意義(P＞0.05),而治療組治療24 h後兩項評分SOFA:(9.18±3.63)vs.(10.62±4.27);APACHEⅡ:(14.92±3.81)vs.(18.21±4.25);P＜0.05及28 d病死率48.39%vs.76.56%,P＜0.05)明顯低于對照組.治療達標組在年齡、平均動脈壓(MAP)和APACHEⅡ評分七與未達標組差異有統計學意義,達標組28d病死率明顯低于未達標組.結論 EGDT可明顯改善膿毒性休剋患者的預後,而年齡、複囌前MAP和APACHEⅡ評分是影響EGDT治療效果的因素.
목적 탐토조기목표도향치료(EGDT)대농독성휴극적치료효과급영향인소.방법 장126례농독성휴극환자분위치료조(n=62)화대조조(n=64),치료조급여EGDT치료,대조조안전통방법진행순배여용량지지,비교량조치료전여치료24 h후서관성기관쇠갈평분(SOFA),급성생리화만성건강상황(APACHEⅡ)평분급28 d병사솔.재치료조중안복소6 h후시부체도복소목표분위체표조(n=40)화미체표조(n=22),비교량조복소전년령、성별、상관혈류동역학지표、SOFA평분、APACHE Ⅱ평분、혈유산수평、28 d병사솔.결과 치료조화대조조치료전량항평분SOFA:(12.26±4.37)vs.(12.54±5.21);KPACHE Ⅱ:(21.26±6.03)vs.(21.64±6.80);차이무통계학의의(P＞0.05),이치료조치료24 h후량항평분SOFA:(9.18±3.63)vs.(10.62±4.27);APACHEⅡ:(14.92±3.81)vs.(18.21±4.25);P＜0.05급28 d병사솔48.39%vs.76.56%,P＜0.05)명현저우대조조.치료체표조재년령、평균동맥압(MAP)화APACHEⅡ평분칠여미체표조차이유통계학의의,체표조28d병사솔명현저우미체표조.결론 EGDT가명현개선농독성휴극환자적예후,이년령、복소전MAP화APACHEⅡ평분시영향EGDT치료효과적인소.
Objective To probe into the treatment effect and the influencing factors of early goal directed therapy(ECDT)in patients with septic shock.Method One hundred and twenty-six patients with septic shock were assigned into the treatment group(n=62)and the control group(n=64).The treatment group was administrated with EGDT,while the control group used conventional therapy for cycle and capacity support.Then sequential organ failure assessment(SOFA)score,APACHE Ⅱ score before treatment and 28-dav-mortality were respectively recorded before the above-mentioned treatment and at 24 hours after the therapy in the two groups.The treatment group was again subdivided into two groups after 6 hours recovery according to the resuscitation results:the sufficiently resuscitated group(n=40)and insufficiently resuscitated group(n=22).Age,genders,correlated haemodynamic parameter,SOFA score,APACHE Ⅱ score and serum lactic acid concentration before resuscitation and 28 d mortality were compared between the two groups.Results There was no significant difference in SOFA score and APACHE Ⅱ score before resuscitation between the treatment group and the control group[SOFA:(12.26±4.37)vs.(12.54±5.21);APACHE Ⅱ:(21.26±6.03)vs.(21.64±6.80)].The two scores at 24 hours after resuscitation[SOFA:(9.18±3.63)vs.(10.62±4.27);APACHEⅡ:(14.92±3.81)vs.(18.21±4.25);P＜0.05]and 28-day-mortality rate(48.39%vs.76.56%,P＜0.05)of the treatment group were significantly lower than those in the control group.There was significant difference in the age,mean arterial pressure (MAP),APACHEⅡ score between the sufficiently restoring group and the insufficiental resuscitated group.The 28-day-mortality of the sufficiently restoring group was significantly lower than that in the insufficiently restoring group.Conclusions EGDT can improve the prognosis in patients with septic shock.Ages,MAP and APPCHE Ⅱ score before resuscitation can be the important factors of EGDT.
