国际医药卫生导报
國際醫藥衛生導報
국제의약위생도보
INTERNATIONAL MEDICINE & HEALTH GUIDANCE NEWS
2013年
24期
3711-3716
,共6页
重症脓毒血症和脓毒血症休克%早期目标导向治疗%降钙素原
重癥膿毒血癥和膿毒血癥休剋%早期目標導嚮治療%降鈣素原
중증농독혈증화농독혈증휴극%조기목표도향치료%강개소원
Severe sepsis and septic shock%Early goal-directed therapy%PCT
目的 评价早期目标导向治疗对重症脓毒血症及脓毒血症休克患者血清降钙素原表达的影响,优化血清降钙素原对重症脓毒血症及脓毒血症休克患者病情反映与预后评估的价值.方法 跟踪调查2012年1月至2013年8月重症脓毒血症及脓毒血症休克确诊患者100例,根据所接受的治疗手段将患者分为治疗组及对照组各50例,同时根据治疗开始时患者血乳酸浓度及中心静脉血氧饱和度(ScvO2)将两组患者分重度全身组织缺氧组,中度全身组织缺氧组,全身组织氧供恢复组.监测患者基本生命体征,中心静脉血氧饱和度,中心静脉压,检测血乳酸及血清降钙素原水平,入院24内完成急性生理与慢性健康(APACHEⅡ)评分,分别比较两组患者6h检测点PCT浓度与APACHEⅡ评分的相关性.入院时及第1、2、3、7、14、21、28天进行多器官功能衰竭评分(MODS),序贯性器官功能衰竭(SOFA)评分.统计两组患者的死亡率.结果 早期液体复苏治疗后的血清降钙素原表达水平能更好地反映患者病情及预后,差异具有统计学意义(P＜0.05);早期液体复苏可降低重症脓毒血症及脓毒血症休克患者血清降钙素原的表达水平(P＜0.01);早期液体复苏治疗有助于重症脓毒血症及脓毒血症休克患者病情改善及预后.结论 血清降钙素原水平与重症脓毒血症及脓毒血症休克病情预后相关;血压、血容量、全身组织氧供的早期改善治疗(EGDT)后的血清降钙素原水平能更好地反映脓毒血症病情分级及病情预后;早期目标导向治疗有助于重症脓毒血症及脓毒血症休克病情改善及预后.
目的 評價早期目標導嚮治療對重癥膿毒血癥及膿毒血癥休剋患者血清降鈣素原錶達的影響,優化血清降鈣素原對重癥膿毒血癥及膿毒血癥休剋患者病情反映與預後評估的價值.方法 跟蹤調查2012年1月至2013年8月重癥膿毒血癥及膿毒血癥休剋確診患者100例,根據所接受的治療手段將患者分為治療組及對照組各50例,同時根據治療開始時患者血乳痠濃度及中心靜脈血氧飽和度(ScvO2)將兩組患者分重度全身組織缺氧組,中度全身組織缺氧組,全身組織氧供恢複組.鑑測患者基本生命體徵,中心靜脈血氧飽和度,中心靜脈壓,檢測血乳痠及血清降鈣素原水平,入院24內完成急性生理與慢性健康(APACHEⅡ)評分,分彆比較兩組患者6h檢測點PCT濃度與APACHEⅡ評分的相關性.入院時及第1、2、3、7、14、21、28天進行多器官功能衰竭評分(MODS),序貫性器官功能衰竭(SOFA)評分.統計兩組患者的死亡率.結果 早期液體複囌治療後的血清降鈣素原錶達水平能更好地反映患者病情及預後,差異具有統計學意義(P＜0.05);早期液體複囌可降低重癥膿毒血癥及膿毒血癥休剋患者血清降鈣素原的錶達水平(P＜0.01);早期液體複囌治療有助于重癥膿毒血癥及膿毒血癥休剋患者病情改善及預後.結論 血清降鈣素原水平與重癥膿毒血癥及膿毒血癥休剋病情預後相關;血壓、血容量、全身組織氧供的早期改善治療(EGDT)後的血清降鈣素原水平能更好地反映膿毒血癥病情分級及病情預後;早期目標導嚮治療有助于重癥膿毒血癥及膿毒血癥休剋病情改善及預後.
목적 평개조기목표도향치료대중증농독혈증급농독혈증휴극환자혈청강개소원표체적영향,우화혈청강개소원대중증농독혈증급농독혈증휴극환자병정반영여예후평고적개치.방법 근종조사2012년1월지2013년8월중증농독혈증급농독혈증휴극학진환자100례,근거소접수적치료수단장환자분위치료조급대조조각50례,동시근거치료개시시환자혈유산농도급중심정맥혈양포화도(ScvO2)장량조환자분중도전신조직결양조,중도전신조직결양조,전신조직양공회복조.감측환자기본생명체정,중심정맥혈양포화도,중심정맥압,검측혈유산급혈청강개소원수평,입원24내완성급성생리여만성건강(APACHEⅡ)평분,분별비교량조환자6h검측점PCT농도여APACHEⅡ평분적상관성.입원시급제1、2、3、7、14、21、28천진행다기관공능쇠갈평분(MODS),서관성기관공능쇠갈(SOFA)평분.통계량조환자적사망솔.결과 조기액체복소치료후적혈청강개소원표체수평능경호지반영환자병정급예후,차이구유통계학의의(P＜0.05);조기액체복소가강저중증농독혈증급농독혈증휴극환자혈청강개소원적표체수평(P＜0.01);조기액체복소치료유조우중증농독혈증급농독혈증휴극환자병정개선급예후.결론 혈청강개소원수평여중증농독혈증급농독혈증휴극병정예후상관;혈압、혈용량、전신조직양공적조기개선치료(EGDT)후적혈청강개소원수평능경호지반영농독혈증병정분급급병정예후;조기목표도향치료유조우중증농독혈증급농독혈증휴극병정개선급예후.
Objective To evaluate the influence of early goal-directed therapy (EGDT) on procalcitonin expression in severe sepsis and septic shock,and optimize serum procalcitonin as a prognostic indicator of severe sepsis and septic shock.Methods 100 cases of severe sepsis and septic shock were collected from January 2012 to August 2013.All patients were divided into treatment group and control group according to predesigned project,50 cases in each group; these two groups were then subdivided into three groups based on the severity of global tissue hypoxia at enrolled time point,namely severe global tissue hypoxia group [lactate ≥ 4 mmol/L and central venous oxyhemoglobin saturation (ScvO2) ＜ 70％],moderate global tissue hypoxia group (2 mmol/L ≤ lactate ＜ 4.0 mmol/L and ScvO2 ＜ 70％) and resuscitation group/resolved global tissue hypoxia group (lactate ＜ 2 mmol/L and ScvO2 ≥ 70％).Patients' vital signs,ScvO2,CVP,blood lactate and serum procalcitonin were observed and recorded.Conducted acute physiology and chronic health evaluation (APACHE 1) within 24 h after enrollment,nultiple organ dysfunction score (MODS) and sequential organ failure assessment (SOFA) 1,2,3,7,14,21 and 28 d after enrollment.Evaluated the correlation between PCT and scores.Results PCT concentration in EGDT group exemplified patients' conditions and prognosis better,with statistically significant difference (P ＜ 0.05).Aggressive fluid resuscitation significantly reduced serum PCT expression in patients with severe sepsis and septic shock (P ＜ 0.01),and improved patients' condition and prognosis.Conclusion Serum procalcitonin is correlated with progress of severe sepsis and septic shock.Aggressive improvement of hemodynamic and oxygen supply (EGDT) can protect patients with severe sepsis and septic shock,and optimize PCT as a prognosis indicator.
