早期目标导向治疗在脓毒性休克中的应用评价  

Evaluation of early goal directed therapy in patients with septic shock

作　　者：嵇朝晖[1] 刘旻[1] 董朝晖[1] 邵学平[1] 

机构地区：[1]湖州市第一人民医院ICU,浙江省湖州313000

出　　处：《中华急诊医学杂志》2009年第4期423-425,共3页Chinese Journal of Emergency Medicine

摘　　要：目的探讨早期目标导向治疗（EGDT）对脓毒性休克的治疗效果及影响因素。方法将126例脓毒性休克患者分为治疗组（n=62）和对照组（n=64），治疗组给予EGDT治疗，对照组按传统方法进行循环与容量支持，比较两组治疗前与治疗24h后序贯性器官衰竭评分（SOFA），急性生理和慢性健康状况（APACHEⅡ）评分及28d病死率。在治疗组中按复苏6h后是否达到复苏目标分为达标组（n=40）和未达标组（n=22），比较两组复苏前年龄、性别、相关血流动力学指标、SOFA评分、APACHEⅡ评分、血乳酸水平、28d病死率。结果治疗组和对照组治疗前两项评分SOFA：（12．26±4．37）vs．（12．54±5．21）；APACHEⅡ：（21．26±6．03）VS．（21．64±6．80）；差异无统计学意义（P〉0．05），而治疗组治疗24h后两项评分SOFA：（9．18±3．63）vs．（10．62±4．27）；APACHEⅡ：（14．92±3．81）VS．（18．21±4．25）；P〈0．05及28d病死率（48．39％vs．76．56％，P〈0．05）明显低于对照组。治疗达标组在年龄、平均动脉压（MAP）和APACHEⅡ评分上与未达标组差异有统计学意义，达标组28d病死率明显低于未达标组。结论EGDT可明显改善脓毒性休克患者的预后，而年龄、复苏前MAP和APACHEⅡ评分是影响EGDT治疗效果的因素。Objective To probe into the treatment effect and the influencing factors of early goal directed therapy（EGDT） in patients with septic shock. Method One hundred and twenty-six patients with septic shock were assigned into the treatment group （ n = 62） and the control group （ n = 64）. The treatment group was administrated with EGDT, while the control group used conventional therapy for cycle and capacity support. Then sequential organ failure assessment（SOFA） score, APACHE Ⅱ score before treatment and 28-day-morality were respectively recorded before the above-mentioned treatment and at 24 hours after the therapy in the two groups. The treatment group was again subdivided into two groups after 6 hours recovery according to the resuscitation results： the sufficiently resuscitated group （ n = 40） and insufficiently resuscitated group （ n = 22） . Age, genders, correlated haemodynamic parameter, SOFA score, APACHE Ⅱ score and serum lactic acid concentration before resuscitation and 28 d mortality were compared between the two groups. Results There was no significant difference in SOFA score and APACHE Ⅱ score before resuscitation between the treatment group and the control group[ SOFA： （12.26 ±4.37） vs. （12.54±5.21）;APACHEH ：（21.26±6.03） vs. （21.64±6.80）].The two scores at 24 hours after resuscitation [SOFA：（9.18±3.63）vs. （10.62±4.27）;APACHEⅡ：（14.92±3.81）vs. （18.21±4. 25）; P 〈0.05] and 28-day-mortahty rate （48.39% vs. 76.56%, P 〈 0.05） of the treatment group were significantly lower than those in the control group. There was significant difference in the age, mean arterial pressure （MAP）, APACHE n score between the sufficiently restoring group and the insufficiently resuscitated group. The 28-day-mortality of the sufficiently restoring group was significantly lower than that in the insufficiently restoring group. Conclusions EGDT can improve the prognosis in patients with septic shock. Ages, MAP and APPCHEⅡ score before resu

关 键 词：脓毒性休克 早期目标导向治疗 序贯性器官衰竭评分 急性生理和慢性健康状况评分Ⅱ 病死率 

分 类 号：R459.7[医药卫生—急诊医学]