CAJ | 학술논문

目的了解感染性休克集柬治疗依从性,以及提高依从性对预后的影响.方法前瞻性研究2007年1月至2008年6月江苏省苏北人民医院重症医学科(ICU)连续收治的成人感染性休克患者临床资料,实验分为培训前(2007年1月至2007年9月)和培训后(2007年10月至2008年6月)两个阶段,研究两个阶段感染性休克集束治疗各项指标的依从性、机械通气时间、ICU住院时间以及28d病死率.计量资料以(-x±s)表示,计数资料以率表示,采用x~2检验,成组t检验,P＜0.05为差异具有统计学意义.结果研究期间共收治符合条件感染性休克患者100例,其中培训前51例,培训后49例.培训前与培训后相比,集束治疗6 h的依从性分别为早期目标导向治疗(EGOT)(19.6%vs.55.1%),红细胞压积HCT(64.7%vs.91.8%),气道内平台压(ss.2%vs.95.9%),激素使用(41.2%vs.62.3%),强心药物使用(41.2%vs.65.3%),血糖控制(45.1%vs.79.6%).同时培训前与培训后相比,集束治疗24 h的依从性分别为早期目标导向治疗(35.3%vs.65.3%),红细胞压积(35.3%vs.73.5%),气道内平台压(86.3%vs.97.9%),激素使用(31.4%vs.69.4%),强心药物使用(52.9%vs.67.3%),血糖控制(47.1%vs.83.7%).培训后机械通气时间明显缩短(P＜0.05)、ICU住院时间明显减少(P＜0.01)及28 d病死率明显降低(55.1%vs.76.5%,P＜0.05),而气道内平台压和24 h强心药物使用差异无统计学意义.结论感染性休克集束治疗依从性低,继续教育培训可以提高依从性,改善感染性休克患者预后.
목적 료해감염성휴극집간치료의종성,이급제고의종성대예후적영향.방법 전첨성연구2007년1월지2008년6월강소성소북인민의원중증의학과(ICU)련속수치적성인감염성휴극환자림상자료,실험분위배훈전(2007년1월지2007년9월)화배훈후(2007년10월지2008년6월)량개계단,연구량개계단감염성휴극집속치료각항지표적의종성、궤계통기시간、ICU주원시간이급28d병사솔.계량자료이(-x±s)표시,계수자료이솔표시,채용x~2검험,성조t검험,P＜0.05위차이구유통계학의의.결과 연구기간공수치부합조건감염성휴극환자100례,기중배훈전51례,배훈후49례.배훈전여배훈후상비,집속치료6 h적의종성분별위조기목표도향치료(EGOT)(19.6%vs.55.1%),홍세포압적HCT(64.7%vs.91.8%),기도내평태압(ss.2%vs.95.9%),격소사용(41.2%vs.62.3%),강심약물사용(41.2%vs.65.3%),혈당공제(45.1%vs.79.6%).동시배훈전여배훈후상비,집속치료24 h적의종성분별위조기목표도향치료(35.3%vs.65.3%),홍세포압적(35.3%vs.73.5%),기도내평태압(86.3%vs.97.9%),격소사용(31.4%vs.69.4%),강심약물사용(52.9%vs.67.3%),혈당공제(47.1%vs.83.7%).배훈후궤계통기시간명현축단(P＜0.05)、ICU주원시간명현감소(P＜0.01)급28 d병사솔명현강저(55.1%vs.76.5%,P＜0.05),이기도내평태압화24 h강심약물사용차이무통계학의의.결론 감염성휴극집속치료의종성저,계속교육배훈가이제고의종성,개선감염성휴극환자예후.
Objective To investigate the compliance with medical care bundles in patients with septic shock and effects of increasing compliance on prognosis.Method From January 2007 to June 2008,a prospective observational study of consecutive patients with septic shock admitted into ICU was carried out.The study was divided into pre-training stage(from January 2007 to September 2007)and post-training stage(from October 2007 to June 2008).The rate of compliance with medical care bundles for sepsis,the duration of mechanical ventilation,the duration of ICU stay and 28-day mortauty in two stages were documented.The percentages for categorical variables and mean±SD for continuous variables were expressed.Chi-square test and unpaired t-test were used for comparisons of groups,and statistical significance defined as P＜0.05.Results One hundred patients met the criteria of septic shock including 51 patients in pre-training stage and 49 patients in post-training stage were enrolled in the study.Compared with the post-training stage,the rates of compliance with 6-hour care bundle for sepsis in pretraining stage were expressed respectively by early goal-directed resuscitation(EGDT,19.6%vs.55.1%),HCT(hematocrit,64.7%vs.91.8%),plateau pressure(88.2%vs.95.9%),corticosteroid therapy(41.2%vs.62.3%),cardiotonic medication(41.2%vs.65.3%)and blood glucose control(45.1%vs.79.6%).At the same time,the rates of compliance with the 24-hour care bundle in pre-training stage in comparison with posttraining stage were respectively expressed in EGDT(35.3%vs.65.3%),HCT(35.3%vs.73.5%),plateau pressure(86.3%vs.97.9%),corticosteroid therapy(31.4%vs.69.4%),administration of positive inotropic medicine(52.9%vs.67.3%)and glucose control(47.1%vs.83.7%).Patients in post-training stage had the shorter duration of mechanical ventilation(P＜0.05),shorter stay in ICU(P＜0.01)and a lower 28-day mortauty rate(55.1%vs.76.5%,P＜0.05)than patients in pre-training stage.There were no significant differences in plateau pressure and cardiotonic medication between two stages.Conclusions The compliance with medical care bundles in patients with septic shock is poor.After training,physician can increase the compliance with medical care bundles for sepsis and improve prognosis.