RASS评分对感染性休克患者改良早期目标导向治疗的探讨  

Evaluation of RASS score for modified early goal-directed therapy on the patients with septic shock

作　　者：毕展建 高飞[1] 时玲燕[1] 高婧[1] 滕海风[1] 

机构地区：[1]威海市立医院重症医学科,山东威海264200

出　　处：《中华医院感染学杂志》2016年第19期4422-4424,共3页Chinese Journal of Nosocomiology

基　　金：山东省卫生厅基金资助项目(SW-2012B029)

摘　　要：目的探讨RASS评分对感染性休克患者改良早期目标导向治疗(EGDT)的价值,以指导临床治疗。方法选取2013年10月-2015年6月医院ICU收治的感染性休克患者92例,按照随机数字表法分为试验组和对照组,每组各46例,试验组采用RASS评分指导镇静+改良EGDT,对照组采用常规镇静+EGDT,观察28d,比较两组患者机械通气时间、住ICU时间、总费用、病死率和多器官功能障碍综合征(MODS)发生率,并观察两组患者6、24h输液量,测定治疗前后肝功能、肾功能指标变化。结果试验组患者机械通气时间、入住ICU时间和住院总费用,均明显低于对照组患者,差异有统计学意义(P<0.05);试验组患者28d病死率和MODS发生率分别为15.2%和34.8%,显著低于对照组患者41.3%和60.9%,差异有统计学意义(P<0.05);试验组患者6、24h输液总量显著高于对照组;两组患者治疗前后肝功能和肾功能指标呈现先升高后下降趋势,在治疗后24h达到最大值。结论 RASS评分对感染性休克患者EGDT具有很大的指导价值,能缩短患者机械通气时间,减少病死率,改善患者预后。OBJECTIVE To discuss the guidance value of RASS score for early goal-directed therapy（EGDT）on the patients with septic shock,so as to guide the clinical treatment.METHODS A total of 92 patients with septic shock from Oct.2013 to Jun.2015 admitted to ICU in our hospital were selected.Patients were divided into test group and control group according to the random number table,with 46 patients in each group.Test group was given the treatment of sedation guided by RASS score＋ EGDT,while control group was given the treatment of conventional sedation ＋ EGDT.After observation for 28 days,the mechanical ventilation time,length of ICU,ICU hospitalization costs,mortality and multiple organ dysfunction syndrome（MODS）incidences were compared between the two groups,and the 6h,24 hfluid volume of two groups were observed,the changes of liver function and renal function of two groups before and after treatment were measured.RESULTS The mechanical ventilation time,staying time of ICU,hospital total costs in test group were significantly lower than control group（P〈0.05）.The 28-day mortality rate and incidence of MODS in test group were 15.2%and 34.8%,which were significantly lower than those in control group 41.3%and 60.9%（P〈0.05）.The total infusion at 6h,and 24 hof test group were significantly higher than those in control group.The liver and renal function index of two groups before and after treatment showed a trend from rise to decline,with maximum value at 24 hafter treatment.CONCLUSIONRASS score has great guidance value for patients with septic shock undergoing EGDT,which could shorten the duration of mechanical ventilation of patients,reduce the mortality rate,and improve the prognosis of patients.

关 键 词：RASS评分 感染性休克 早期目标指导治疗 

分 类 号：R631.4[医药卫生—外科学]