重症肺炎及感染性休克的集束治疗  

Effects of sepsis bundles on severe pneumonia and septic shock

作　　者：郭琦[1,2] 黎毅敏[1] 农凌波[1] 徐远达[1] 何国清[1] 何为群[1] 陈思蓓[1] 刘晓青[1] 李静[1] 江梅[1] 徐永昊[1] 肖正伦[1] 钟南山[1] 

机构地区：[1]广州医学院第一附属医院广州呼吸疾病研究所,广州510120 [2]广东医学院附属福田医院呼吸科

出　　处：《中华急诊医学杂志》2009年第3期286-292,共7页Chinese Journal of Emergency Medicine

基　　金：基金项目：广州市科技局基金项目（2004Y1-H0131）

摘　　要：目的探讨国内严重感染集束治疗的疗效。方法在广州医学院附属第三医院呼吸重症监护病房中选用43例重症肺炎及感染性休克患者，进行14个月（2006年11月1日至2007年12月31日）前瞻性观察研究。患者入进标准参照2001年国际脓毒症会议。分教育、试验和运作3个连续阶段实施6h严重感染集束治疗和24h严重感染集束治疗。历史对照期内（2004年1月1日至2006年10月31日）合格患者归入对照组。计量资料以（x^-±s）表示，计数资料以率表示。采用70检验、独立样本t检验、配对t检验、单因素和多因素Logistic回归分析，P〈0．05为差异具有统计学意义。结果1）对照组和集束治疗组间的基础特征差异基本上无统计学意义。2）血清乳酸测定率、休克亚组液体复苏率及6h内所输入液体量、血糖控制，与对照组相比较，其差异均有统计学意义（P值分别是0．024，0．009，0．045和0．000）。3）72h时，集束治疗组呼吸频率和氧合指数，与对照组相比较，其差异均有统计学意义（P值分别是0．033和0．041）；集束治疗组中休克亚组急性生理和慢性疾病评分（APACHE）Ⅱ分值和预计死亡率的下降值，与对照组中休克亚组比较，其差异均有统计学意义（P值分别是0．017和0．040）。4）与对照组比较，集束治疗组病死率绝对值下降23．30％（P=0．019）。结论严重感染集束治疗能显著降低重症肺炎及感染性休克患者病死率。Objective To investigate the effects of sepsis bundles in China. Method An observational study of 43 patients with severe pneumonia and septic shock admitted to the respiratory intensive care unit （1/11/ 2006 - 31/12/2007） was carried out. The selection criteria were in accordance with criteria set by International Conference On Sepsis in 2001. Implementation of 6 hours and 24 hours sepsis bundles was divided into 3 continuous phases consisting of education, trial, and application phase. A cohort of 43 patients with matched disease history （1/1/2004- 31/10/2006）was enrolled as control group. The percentages for categorical variables and mean ±SD for continuous variables were reported. Chi-Square test, unpaired Student＇s t-test, paired-samples t test, univariate and multivariate logistic regression models were used. Statistical significance was defined as P 〈 0.05. Results There were very little significant differences in basic characteristics of patients between the two groups. Compared with control group, the differences in seram lactate, fluid resuscitation and fluid volume infused within 6 hours and blood glucose control in shock subgroup were significant （P values were 0.024, 0.009, 0.045, and 0.000, respectively）. Compared with control group, the differences in respiratory rate and oxygenation index of bundles group at 72 hours later were significant （ P values were 0.033 and 0.041, respectively）. Compared with control group, the differences in APACHE Ⅱ score and predicted mortality in shock subgroup of bundles were significant （P values were 0,017 and 0.040, respectively）. Compared with control group, the reduction in absolute mortality was 23.30% in bundles group （P = 0.019）. Conclusions Implementation of sepsis bandies contributes noticeably to the significant reduction in mortality of patients with severe pneumonia and septic shock.

关 键 词：重症肺炎 感染性休克 集束治疗 病死率 

分 类 号：R459.7[医药卫生—急诊医学]