提高集束治疗依从性对感染性休克预后的影响  

Effects of increasing compliance with medical care bundles on prognosis in patients with septic shock

作　　者：陈齐红[1] 郑瑞强[1] 汪华玲[2] 林华[1] 卢年芳[1] 邵俊[1] 於江泉[1] 窦英茹[1] 

机构地区：[1]江苏省苏北人民医院&扬州大学临床医学院ICU,江苏省扬州225000 [2]江苏省苏北人民医院&扬州大学临床医学院心内科,江苏省扬州225000

出　　处：《中华急诊医学杂志》2010年第2期150-153,共4页Chinese Journal of Emergency Medicine

基　　金：江苏省“333高层次人才培养工程”基金资助（2007-58）

摘　　要：目的了解感染性休克集束治疗依从性，以及提高依从性对预后的影响。方法前瞻性研究21307年1月至2008年6月江苏省苏北人民医院重症医学科（ICU）连续收治的成人感染性休克患者临床资料，实验分为培训前（2007年1月至21307年9月）和培训后（2007年10月至2008年6月）两个阶段，研究两个阶段感染性休克集束治疗各项指标的依从性、机械通气时间、ICU住院时间以及28d病死率。计量资料以（x±s）表示，计数资料以率表示，采用χ2检验，成组t检验，P〈0．05为差异具有统计学意义。结果研究期间共收治符合条件感染性休克患者100例，其中培训前51例，培训后49例。培训前与培训后相比，集束治疗6h的依从性分别为早期目标导向治疗（EGDT）（19．6％vs．55．1％），红细胞压积Hcr（64．7％vs．91．8％），气道内平台压（88．2％vs．95．9％），激素使用（41．2％vs．62．3％），强心药物使用（41．2％vs．65．3％），血糖控制（45．1％vs．79．6％）。同时培训前与培训后相比，集束治疗24h的依从性分别为早期目标导向治疗（35．3％vs．65．3％），红细胞压积（35．3％vs．73．5％），气道内平台压（86．3％vs．97．9％），激素使用（31．4％vs．69．4％），强心药物使用（52．9％vs．67．3％），血糖控制（47．1％vs．83．7％）。培训后机械通气时间明显缩短（P〈0．05）、ICU住院时间明显减少（P〈0．01）及28d病死率明显降低（55．1％VS．76．5％，P〈0．05），而气道内平台压和24h强心药物使用差异无统计学意义。结论感染性休克集束治疗依从性低，继续教育培训可以提高依从性，改善感染性休克患者预后。Objective To investigate the compliance with medical care bundles in patients with septic shock and effects of increasing compliance on prognosis. Method From January 2007 to June 2008, a prospective ob- servational study of consecutive patients with septic shock admitted into ICU was carried out. The study was divided into pre-training stage （from January 2（D7 to September 2007） and post-training stage （from October 2（}07 to June 2008）. The rate of compliance with medical care bundles for sepsis, the duration of mechanical ventilation, the duration of ICU stay and 28-day mortality in two stages were documented. The percentages for categorical variables and mean ＋ SD for continuous variables were expressed. Chi-square test and unpaired t -test were used for compar- isons of groups, and statistical significance defined as P 〈 0.05. Results One hundred patients met the criteria of septic shock including 51 patients in pre-training stage and 49 patients in pest-training stage were enrolled in the study. Compared with the post-training stage, the rates of compliance with 6- hour care bundle for sepsis in pre- training stage were expressed respectively by early goal-directed resuscitation （EGDT, 19.6% vs. 55.1% ）, HCY （hematocrit, 64.7% vs. 91.8%）, plateau pressure （88.2% vs. 95.9%）, corticostemid therapy （41.2% vs.62.3 % ）, cardiotonie medication （41.2 % vs. 65.3 % ） and blood glucose control （45.1% vs. 79.6 % ）. At the same time, the rates of compliance with the 24-hour cam bundle in pre-training stage in eomparisen with post- training stage were respectively expressed in EGDT （35.3 % vs. 65.3 % ）, HCT （35.3 % vs. 73.5 % ）, plateau pressure （86.3 % vs. 97.9 % ）, eortieosteroid therapy （31.4 % vs. 69.4% ）, administration of positive inotmpie medicine （52.9 % vs. 67.3 % ） and glucose eontrol （47.1% vs. 83.7 % ）. Patients in post-training stage had the shorter duration of mechanical ventilation （ P 〈 0.05）, shorter stay in ICU （ P 〈 0.01 ） and

关 键 词：感染性休克 集束治疗 依从性 预后 ICU EGDT 培训 临床研究 

分 类 号：R686[医药卫生—骨科学]