早期复苏对脓毒症合并低灌注后续治疗的效果评价  

The effects of earlier resuscitation on following therapeutic response in sepsis with hypoperfusion

作　　者：瞿洪平[1] 秦帅[2] 闵东[2] 汤耀卿[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院RICU,200025 [2]上海交通大学医学院附属瑞金医院SICU

出　　处：《中华外科杂志》2006年第17期1193-1196,共4页Chinese Journal of Surgery

摘　　要：目的探讨脓毒症合并低灌注患者早期充分复苏对后续治疗效果的影响。方法2004年6月至2005年12月,我院外科和呼吸重症加强治疗病房连续收治的脓毒症合并低灌注患者共34例,进行及时充分复苏治疗。根据复苏达标时间是否超过12 h将患者分为早期复苏组(15例)和晚期复苏组(19例),并比较两组患者对后续治疗的反应和脏器功能影响。结果早期充分复苏后,晚期复苏组需再次复苏治疗的占73．7％,早期复苏组为20．0％(P<0．01);晚期复苏组需激素替代治疗者为63．2％,凝血功能障碍和多器官功能障碍综合征的发生率分别为73．7％和68．4％,均显著高于早期复苏组(P<0．05)。复苏后第7天,早期复苏组血肌酐显著低于晚期复苏组(P<0．05);复苏后,早期复苏组各时点心率均显著低于晚期复苏组(P<0．05);复苏7天后,早期复苏组氧分压和氧合指数均显著高于晚期复苏组(P<0．05)。晚期复苏组院内病死率为42．1％,早期复苏组13．3％(P<0．05)。结论早期充分复苏治疗可明显增强脓毒症患者对后续治疗的敏感性,并减轻炎症和凝血反应对重要脏器的损害,从而降低其病死率。Objective To evaluate the effects of early sufficient resuscitation on important organs function and their therapeutic response in sepsis with hypoperfusion. Methods From January 2004 to December 2005, 34 sepsis patients with hypoperfusion in surgical and respiratory intensive care units were resuscitated sufficiently for the management of severe sepsis and septic shock. According to the time of resuscitation end points, these patients were divided to early resuscitation group （E group, 15 patients） and later group （L group, 19 patients）. The important organs function and their therapeutic response followed resuscitation were investigated and compared in the tow groups. Results After earlier sufficient resuscitation, the incidence of repeated resuscitation was 73.7% in L group and 20. 0% in E group （ P 〈 0. 01 ）; the incidence of steroids replacement, coagulation dysfunction and multiple organ dysfunction syndrome （MODS） were 63.2%, 73.7% and 68.4% respectively in L group and significantly higher than those in E group （P 〈 0. 05）. Seven days after resuscitation, the level of serum creatinine in E group was lower than that in L group （P 〈 0. 05 ）. In the day 1 and 7 after resuscitation, heart rate in E group was lower than that in L group （ P 〈 0. 05）. Seven days post resuscitation, PaO2 and PaO2/FiO2 were higher in E group than in L group （P 〈 0. 05）. The mortality was 42. 1% in L group and 13.3% in E group （P 〈 0.05）. Conclusions Early sufficient resuscitation in sepsis patients with hypoperfusion could significantly enhance the effects of following treatment, relieve inflammation and coagulation reaction and thereby reduce the mortality.

关 键 词：脓毒症 复苏术 治疗 

分 类 号：R459.7[医药卫生—急诊医学]