CAJ | 학술논문

目的：探讨早期目标导向治疗（EGDT）对重度脓毒血症患者血清降钙素原（PCT）水平及预后的影响。方法重度脓毒血症患者58例随机分为EGDT组和对照组各29例。2组均积极控制感染、机械通气等基础治疗，EGDT组采取以早期复苏为中心的综合疗法，对照组采用循环与容量支持等常规治疗。比较分析入院不同时间的血清PCT水平、APACHE II评分，记录EGDT达标时间、7 d急性肾损伤（ AKI）、多器官功能衰竭（ MODS）的发生率及28d病死率，并分析各指标间的相关性。结果2组第3、5、7天PCT水平均低于入院时（P＜0．05），入院第3天、5天、7天，EGDT组患者PCT水平均明显低于对照组（ P ＜0．05）；EGDT组中≤6 h达标者入院第5天、7天 PCT水平明显低于＞6 h达标者（ P ＜0．05）；EGDT组患者入院7 d APACHE II评分、MODS发生率、7天AKI发病率显著低于对照组（ P ＜0．05）；7 d APACHE II评分、MODS发生率、7 d AKI发病率均与PCT呈正相关（ r ＝0．651、0．401、0．395， P ＜0．05）。结论重度脓毒症患者尽早行EGDT，可快速降低血清PCT水平，改善患者的预后，且与达标时间密切相关。
목적：탐토조기목표도향치료（EGDT）대중도농독혈증환자혈청강개소원（PCT）수평급예후적영향。방법중도농독혈증환자58례수궤분위EGDT조화대조조각29례。2조균적겁공제감염、궤계통기등기출치료，EGDT조채취이조기복소위중심적종합요법，대조조채용순배여용량지지등상규치료。비교분석입원불동시간적혈청PCT수평、APACHE II평분，기록EGDT체표시간、7 d급성신손상（ AKI）、다기관공능쇠갈（ MODS）적발생솔급28d병사솔，병분석각지표간적상관성。결과2조제3、5、7천PCT수평균저우입원시（P＜0．05），입원제3천、5천、7천，EGDT조환자PCT수평균명현저우대조조（ P ＜0．05）；EGDT조중≤6 h체표자입원제5천、7천 PCT수평명현저우＞6 h체표자（ P ＜0．05）；EGDT조환자입원7 d APACHE II평분、MODS발생솔、7천AKI발병솔현저저우대조조（ P ＜0．05）；7 d APACHE II평분、MODS발생솔、7 d AKI발병솔균여PCT정정상관（ r ＝0．651、0．401、0．395， P ＜0．05）。결론중도농독증환자진조행EGDT，가쾌속강저혈청PCT수평，개선환자적예후，차여체표시간밀절상관。
Objective To investigate the early goal directed therapy ( EGDT) on severe sepsis patients ’ serum calci-toninpeptide(PCT)levels.Methods 58 cases of severe sepsis patients were randomly divided into EGDT group and control group with 29 cases in each group .Both of the 2 groups were received active control of infection , mechanical ventilation and other basic treatment , the EGDT group received early recovery as the key part of the comprehensive treatment , the control group received conventional treatment , such as circulation and capacity support .The different admission time , serum PCT lev-el, APACHE II score, recording rate and 28 day mortality incidence of EGDT standard time , 7 days of acute kidney injury (AKI) and multiple organ failure (MODS) were compared between the two groups , and the correlation among the indexes were analyzed.Results The 2 groups’ 3, 5, 7 days’ PCT levels were lower than the admission ( P <0.05), after 3 days, 5 days, 7 days of admission , EGDT group of patients with PCT levels were significantly lower than those of the control group (P<0.05);the EGDT group’s patients who with less than or equal to 6 h standards, when admitted to hospital at 5 days, 7 days, the PCT level was significantly lower than those whose >6 h standards ( P <0.05);the EGDT group of patients ’ 7 days’ APACHE II score and MODS incidence, 7 days’ AKI incidence was significantly lower than that of control group (P <0.05);7 days’ APACHE II score and MODS incidence, 7 days AKI incidence rate were positively correlated with PCT (r=0.651, r =0.401, r =0.395, P <0.05).Conclusion Severe sepsis patients should received EGDT as early as possi-ble, it can rapidly reduce serum PCT levels , improve prognosis , and is closely related to the standard time .