外科严重脓毒症早期目标指导治疗应用价值研究  

Value of early goal-directed therapy for treatment of surgical patients with severe sepsis

作　　者：戴海文[1] 张召才[1] 严静[1] 蔡国龙[1] 龚仕金[1] 虞意华[1] 陈进[1] 谭成戊[1] 颜墨磊[1] 吴亮[1] 

机构地区：[1]浙江医院ICU,浙江杭州310013

出　　处：《中国实用外科杂志》2009年第12期1000-1002,共3页Chinese Journal of Practical Surgery

基　　金：浙江省医药卫生重点科研项目(2004ZD002);浙江省卫生高层次创新人才基金;浙江省医药卫生科技计划项目(2006A012)

摘　　要：目的探讨早期目标指导治疗(EGDT)治疗外科严重脓毒症临床价值。方法将2004年8月至2007年6月收治于浙江省7家三甲医院ICU的177例外科严重脓毒症病人随机分为常规组(n=90)和EGDT组(n=87)。前者以中心静脉压(CVP)、平均动脉压(MAP)或收缩压(SBP)、尿量(UO)变化指导液体复苏,后者在此基础上增加中心静脉血氧饱和度(ScvO2)为观测指标进行复苏;入选后,对病人行输液、输血和强心等治疗,6h内达标;比较两组病人28d存活率(主要终点)、ICU住院时间、机械通气时间、抗生素使用时间、合并新感染情况和临床评分(次要终点)的差异。结果EGDT组28d存活率较常规组增高约18%(79.3%vs61.1%,P=0.023),EGDT明显改善APACHEII评分(21.7±5.9vs15.4±4.3,P=0.008)和MODS评分(8.4±3.3vs5.1±2.9,P=0.017),EGDT对其他次级终点均无显著影响(均P>0.05)。结论EGDT可以显著改善外科脓毒症病人28d存活率和临床评分,对病人预后有益。Objective To investigate the effect of early goal-directed therapy （EGDT） on surgical patient with severe sepsis. Methods One hundred and seventy-seven surgical patients with severe sepsis admitted between August 2004 and June 2007 at 7 hospitals of Grade III Level A in Zhejiang Province were randomized to conventional treatment group （n=90） and EGDT group （n=87）, the former was underwent fluid resuscitation goaled by central venous pressure （CVP）, mean artery blood pressure （MBP） or systolic blood pressure （SBP） and urinary output, and the latter was guiding by CVP, MBP or SBP and UO plus central venous oxygen saturation （ScvO2）; The patients were achieved the goals by treating with fluid, transfusions and cardiac stimulants in a period of 6 hours after enrollment. The difference of 28-day survival （primary endpoint）, the length of stay in ICU, mechanical ventilation time, antibiotics utilization time, complication of newly infection and clinical scores （secondary endpoints） between the 2 groups was compared. Results In comparison with conventional group, the 28-day survival of EGDT group was increased by 18% （79.3% vs 61.1%, P= 0.023）, the APACHE II score and MODS score were significantly improved after 6h of EGDT fluid resuscitation （APACHE Ⅱ： 21.7±5.9 vs 15.4±4.3, P=0.008; MODS： 8.4±3.3 vs 5.1 ±2.9, P=0.017）, there is no difference in other parameters for secondary endpoint （all P〉0.05）. Conclusion EGDT improved 28-day survival and clinical scores and had beneficial effects on outcomes in surgical patients with severe sepsis.

关 键 词：脓毒症 液体复苏 

分 类 号：R6[医药卫生—外科学]