中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2009年
1期
8-12
,共5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
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
곽기%려의민%농릉파%서원체%하국청%하위군%진사배%류효청%리정%강매%서영호%초정륜
感染,严重%休克,感染性%集束治疗%依从性
感染,嚴重%休剋,感染性%集束治療%依從性
감염,엄중%휴극,감염성%집속치료%의종성
severe sepsis%septic shock%bundle treatment%compliance
目的 评价三级医院严重感染集束治疗的依从性,为推广指南积累相关数据.方法 在广州医学院第一附属医院呼吸重症监护病房中选择2006年11月1日-2007年12月31日43例重症肺炎及感染性休克患者进行前瞻性观察研究(集束治疗组),分教育、试验和运作3个阶段实施6 h严重感染集束治疗和24 h严重感染集束治疗.选择2004年1月1日-2006年10月31 日在院治疗的43例患者作为历史对照组.结果 ①6 h集束治疗中:血清乳酸测定率为20.9%(9/43);抗生素治疗前获取血培养的实施率为7.0%(3/43);100.0%(43/43)能在1 h内给予经验性抗生素治疗;44.2%(19/43)输入20 ml/kg的晶体液或等量胶体液(20%白蛋白1.1 ml/kg或6%羟乙基淀粉4.8 ml/kg),6 h内输入液体量(折算为6%羟乙基淀粉剂量)为(503.95±176.19)ml;94.7%(18/19)应用血管收缩剂;7.0%(3/43)使用正性肌力药多巴酚丁胺和(或)输浓缩红细胞.②24 h集束治疗中:小剂量类固醇使用率为31.6%(6/19);34.9%(15/43)的患者血糖控制在8.3 mmol/L以内;吸气末平台压<30 cm H2O(1 cm H2O=0.098 kPa,潮气量为6 ml/kg)的机械通气患者占97.6%(40/41).③6 h和24 h严重感染集柬治疗的依从性分别是0和21.4%,整体依从性为0.④与对照组比较,集束治疗组病死率绝对值下降了23.3%(18.6%比41.9%,P=0.019).结论 目前本院严重感染集束治疗仅能达到部分依从.提示国内推广严重感染和感染性休克管理指南依然任重道远.
目的 評價三級醫院嚴重感染集束治療的依從性,為推廣指南積纍相關數據.方法 在廣州醫學院第一附屬醫院呼吸重癥鑑護病房中選擇2006年11月1日-2007年12月31日43例重癥肺炎及感染性休剋患者進行前瞻性觀察研究(集束治療組),分教育、試驗和運作3箇階段實施6 h嚴重感染集束治療和24 h嚴重感染集束治療.選擇2004年1月1日-2006年10月31 日在院治療的43例患者作為歷史對照組.結果 ①6 h集束治療中:血清乳痠測定率為20.9%(9/43);抗生素治療前穫取血培養的實施率為7.0%(3/43);100.0%(43/43)能在1 h內給予經驗性抗生素治療;44.2%(19/43)輸入20 ml/kg的晶體液或等量膠體液(20%白蛋白1.1 ml/kg或6%羥乙基澱粉4.8 ml/kg),6 h內輸入液體量(摺算為6%羥乙基澱粉劑量)為(503.95±176.19)ml;94.7%(18/19)應用血管收縮劑;7.0%(3/43)使用正性肌力藥多巴酚丁胺和(或)輸濃縮紅細胞.②24 h集束治療中:小劑量類固醇使用率為31.6%(6/19);34.9%(15/43)的患者血糖控製在8.3 mmol/L以內;吸氣末平檯壓<30 cm H2O(1 cm H2O=0.098 kPa,潮氣量為6 ml/kg)的機械通氣患者佔97.6%(40/41).③6 h和24 h嚴重感染集柬治療的依從性分彆是0和21.4%,整體依從性為0.④與對照組比較,集束治療組病死率絕對值下降瞭23.3%(18.6%比41.9%,P=0.019).結論 目前本院嚴重感染集束治療僅能達到部分依從.提示國內推廣嚴重感染和感染性休剋管理指南依然任重道遠.
목적 평개삼급의원엄중감염집속치료적의종성,위추엄지남적루상관수거.방법 재엄주의학원제일부속의원호흡중증감호병방중선택2006년11월1일-2007년12월31일43례중증폐염급감염성휴극환자진행전첨성관찰연구(집속치료조),분교육、시험화운작3개계단실시6 h엄중감염집속치료화24 h엄중감염집속치료.선택2004년1월1일-2006년10월31 일재원치료적43례환자작위역사대조조.결과 ①6 h집속치료중:혈청유산측정솔위20.9%(9/43);항생소치료전획취혈배양적실시솔위7.0%(3/43);100.0%(43/43)능재1 h내급여경험성항생소치료;44.2%(19/43)수입20 ml/kg적정체액혹등량효체액(20%백단백1.1 ml/kg혹6%간을기정분4.8 ml/kg),6 h내수입액체량(절산위6%간을기정분제량)위(503.95±176.19)ml;94.7%(18/19)응용혈관수축제;7.0%(3/43)사용정성기력약다파분정알화(혹)수농축홍세포.②24 h집속치료중:소제량류고순사용솔위31.6%(6/19);34.9%(15/43)적환자혈당공제재8.3 mmol/L이내;흡기말평태압<30 cm H2O(1 cm H2O=0.098 kPa,조기량위6 ml/kg)적궤계통기환자점97.6%(40/41).③6 h화24 h엄중감염집간치료적의종성분별시0화21.4%,정체의종성위0.④여대조조비교,집속치료조병사솔절대치하강료23.3%(18.6%비41.9%,P=0.019).결론 목전본원엄중감염집속치료부능체도부분의종.제시국내추엄엄중감염화감염성휴극관리지남의연임중도원.
Objective To evaluate compliance with bundle treatment in the management of severe infection in a tertiary hospital,aiming at analyzing clinical data in order to popularize guidelines for management of severe sepsis and septic shock.Methods A 14-month(from November 1,2006 to December 31,2007)prospective observationsl study of a group of 43 patients admitted to the respiratory intensive care unit in First Affiliated Hospital(tertiary hospital)of Guangzhou Medical College meeting the criteria for severe pneumonia and septic shock was carried out.Implementation of 6-hour and 24-hour bundle treatment for severe infection was divided into three phases consisting of education,trial,and application.A cohort of 43 patients with matched disease history admitted during January 1,2004 to October 31,2006 were enrolled as control group.Results ① In 6-hour bundle treatment for severe infection,20.9%(9/43) had serum lactate meassured,blood culture was obtained prior to antibiotic administration in 7.0H(3/43)of patients,100%(43/43)had empirical antibiotics administration within 1 hour,an injusion of an initial minimum of 20 ml/kg of crystalloid or colloid equivalent(1.1 ml/kg of 20%albumin or 4.8 ml/kg of 6% hydroxyethyl starch)was given in 44.2%(19/43),with infused fluid(converted into 6% hydroxyethyl starch)reaching(503.95±176.19)ml within 6 hours,in 94.7%(18/19)of patients had received vasopressors,and inotropic dobutamine and/or transfusion of packed red blood cells were administered in 7.0%(3/43).② In 24-hour bundle treatment for severe infection group,31.6%(6/19)had received low-dose steroids,34.9%(15/43)had their blood glucose controlled<8.3 mmol/L,mechanical ventilation with inspiratory plateau pressures maintained<30 am H20(1 cm H2O=0.098 kPa,6 ml/kg tidal volume) was instituted in 97.6%(40/41)of patients.③ The percentage of compliance with 6-hour and 24-hour bundle treatment for severe infection were 0 and 21.4% respectively,total compliance was also 0.④ As compared with control group,a 23.30% absolute mortality reduction was found in bundle group(18.6%vs.41.9%,P=0.019).Conclusion Bundle treatment for severe infection is complied with partially in our hospital,suggesting that it is still quite arduous to popularize guidelines for management of severe sepsis and septic shock in our country.