CAJ | 학술논문

目的探讨不同程度控制体温对感染性休克患者器官功能及预后的影响.方法核心体温(肛温)超过38.5℃的67例难治性感染性休克患者全部采用水流式冰毯降温72 h,记录核心体温和外周体温(腋温).以降温期间平均核心体温是否超过37.5℃分为T37.5 ～38.3℃组和T＜37.5℃组.记录所有患者WBC、中性粒细胞比例、肌钙蛋白和凝血酶原时间(PT)、APTT、国际标准化比值(INR)、序贯器官衰竭评分(SOFA)、28 d病死率、ICU留治时间.结果 67例患者中T37.5 ～38.3℃组34例,T＜ 37.5℃组33例.ASOFA T 37.5 ～ 38.3℃组为(1.30 ±0.90)分,T＜37.5℃组为(2.30 ±2.10)分,2组比较差异有统计学意义(P=0.02).2组肌钙蛋白、PT、APTT、INR、ICU留治时间比较差异均有统计学意义(P值均＜0.05).28 d病死率T 37.5 ～38.3℃组为35.3％,T＜37.5℃组为69.7％,2组比较差异有统计学意义(P=0.005).Cox回归分析显示,平均核心体温是患者28 d病死率的独立危险因素.结论发热难治性感染性休克患者控制核心体温至正常范围并不能缓解多脏器功能不全的进程,反而加快这一过程,增加患者的病死率.
목적 탐토불동정도공제체온대감염성휴극환자기관공능급예후적영향.방법 핵심체온(항온)초과38.5℃적67례난치성감염성휴극환자전부채용수류식빙담강온72 h,기록핵심체온화외주체온(액온).이강온기간평균핵심체온시부초과37.5℃분위T37.5 ～38.3℃조화T＜37.5℃조.기록소유환자WBC、중성립세포비례、기개단백화응혈매원시간(PT)、APTT、국제표준화비치(INR)、서관기관쇠갈평분(SOFA)、28 d병사솔、ICU류치시간.결과 67례환자중T37.5 ～38.3℃조34례,T＜ 37.5℃조33례.ASOFA T 37.5 ～ 38.3℃조위(1.30 ±0.90)분,T＜37.5℃조위(2.30 ±2.10)분,2조비교차이유통계학의의(P=0.02).2조기개단백、PT、APTT、INR、ICU류치시간비교차이균유통계학의의(P치균＜0.05).28 d병사솔T 37.5 ～38.3℃조위35.3％,T＜37.5℃조위69.7％,2조비교차이유통계학의의(P=0.005).Cox회귀분석현시,평균핵심체온시환자28 d병사솔적독립위험인소.결론 발열난치성감염성휴극환자공제핵심체온지정상범위병불능완해다장기공능불전적진정,반이가쾌저일과정,증가환자적병사솔.
Objective To investigate the effect of body temperature control on organ function and prognosis in patients with refractory septic shock.Methods A total of 67 eligible patients with the body temperature over 38.5 ℃ were enrolled in the study and all patients were treated with a water-flow cooling blanket to control the body temperature below 38.3 ℃ for 72 hours.The core and peripheral temperature was tested at 1 hour interval.All patients were devised into the following two groups according to their mean core temperature within the 72 hours:the HT group with a mean core temperature ≥ 37.5 ℃ and the LT group with a mean core temperature ＜ 37.5 ℃.Hemodynamic,respiratory,and laboratory parameters were tested every 6 hours during the first 72 hours after the temperature increased above 38.5 ℃.Results Thirty-four patients (50.7％) were classified into the HT group,while thirty-three patients (49.3％) were in the LT group.Compared with the HT group,higher mortality rate at Day 28 was observed in the LT group (69.7％vs 35.3％,P =0.005).Significant difference in the increase of sepsis-related organ failure assessment (SOFA) score was found between of the HT and the LT groups (1.30 ± 0.90 vs 2.30 ± 2.10,P =0.02).Statistical differences were observed between the two groups in mean core temperature [(37.90 ± 0.30) ℃ vs (36.80 ± 0.60) ℃,P ＜ 0.000 1],mean peripheral temperature [(37.20 ± 0.30) ℃ vs (36.30 ± 0.60) ℃,P ＜0.000 1],minimum core temperature [(36.90 ±0.30)℃ vs (35.80 ±0.60) ℃,P＜0.000 1] and minimum peripheral temperature [(36.20 ± 0.40) ℃ vs (35.50 ± 0.60) ℃,P ＜ 0.000 1],but not in maximum core and peripheral temperature.Statistical difference was also shown in troponin I,fibrinogen,partial thromboplatin and activated partial thromboplatin between the two groups.Cox regression analysis revealed that the mean core temperature was the only independent predictor for the mortality rate at Day 28.Conclusion Body temperature control within the normal range may exert potentially detrimental effect on organ function and prognosis in patients with refractory septic shock with fever.