改良式早期目标指导治疗对感染性休克患者预后的影响  

Effect of modified early goal directed therapy on the prognosis of patients with septic shock

作　　者：杨军辉[1] 喻莉[1] 武晓灵[1] 龙鼎[1] 张远超[1] 

机构地区：[1]湖北省武汉市中心医院ICU,430014

出　　处：《重庆医学》2015年第1期31-33,共3页Chongqing medicine

基　　金：湖北省武汉市卫生局临床医学科研项目(WX13C06)

摘　　要：目的探讨改良式早期目标指导治疗(EGDT)对感染性休克患者预后的影响。方法回顾性分析2011年1月至2013年3月入住该院ICU 116例感染性休克患者的临床资料,按照治疗方法不同分为改良式EGDT组(n=57)和传统EGDT组(n=59),比较两组患者28d生存率。改良式EGDT组根据28d预后分为存活组(n=46)和死亡组(n=11),比较存活组和死亡组患者的性别、年龄、升压药使用时间、24h内复苏液体量、机械通气时间、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯性器官衰竭评分(SOFA)、多器官功能障碍综合征(MODS)评分等相关指标。结果改良式EGDT组28d生存率较传统EGDT组增高约18.9%(P<0.05)。改良式EGDT组中死亡患者的APACHⅡ评分、SOFA评分和MODS评分均较存活患者明显升高,分别为[(29.36±1.57)d vs.(24.30±3.27)d],[(13.45±0.52)d vs.(12.78±1.33)d],[(9.00±0.00)d vs.(4.04±1.94)d],且升压药物使用时间和机械通气时间明显延长(P<0.05)。结论改良式早期目标指导治疗可以显著降低感染性休克患者的病死率,改善患者预后。Objective To evaluate the effects of modified early goal directed therapy （EGDT ）on the prognosis of patients with septic shock .Methods Clinical data of 116 patients with septic shock admitted to ICU during January 2011 to March 2013 were retrospectively analyzed .Patients were divided into modified early goal-directed therapy group （n=57） and traditional early goal-directed therapy group （n=59） according to different methods of treatment ,the patients′28-day survival rates of these 2 groups were compared .Modified early goal-directed therapy are divided into survival group （n=46） and non-survival group （n=11） according to 28-day prognosis .Acute physiology and chronic health evaluation Ⅱ （APACHEⅡ ） score ,sequential organ failure assessment （SOFA） ,multiple organ dysfunction syndrome （MODS） score and other relevant indicators of survival group and non-survival group were compared .Results The 28-day survival rate in modified early goal-directed therapy group had increased approximately 18 .9% higher than that of the traditional early goal-directed therapy group（P〈 0 .05） .The APACH Ⅱ score ,SOFA score and MODS score in non-survivors were significantly higher than those of survivors in modified EGDT group ,which were[（29 .36 ± 1 .57）d vs .（24 .30 ± 3 .27）d] ,[（13 .45 ± 0 .52）d vs .（12 .78 ± 1 .33）d] ,[（9 .00 ± 0 .00）d vs .（4 .04 ± 1 .94）d]separately .And vaso-pressors time and mechanical ventilation time was significantly longer in non-survivors than survivors（P〈0 .05） .Conclusion Mod-ified early goal directed therapy could improve 28-day survival rate ,and it show s beneficial effects on outcome of critical patients w ith septic shock .

关 键 词：感染 休克 改良式早期目标指导治疗 预后 

分 类 号：R631.4[医药卫生—外科学]