胃肠手术后严重感染和感染性休克的集束化治疗研究  

Bundle therapy of severe infections and septic shock after gastrointestinal surgery

作　　者：汪增方 王公平[2] 陈晔[2] 金灿辉[2] 张伟[2] 孟元普[2] 

机构地区：[1]洛阳市第六人民医院普外科,河南洛阳471000 [2]河南科技大学第一附属医院胃肠肿瘤外科,河南洛阳471000

出　　处：《中华医院感染学杂志》2017年第24期5622-5625,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨应用集束化治疗胃肠手术后严重感染和感染性休克患者的临床疗效。方法选择2013年1月-2016年1月于医院就诊的胃肠手术后严重感染合并感染性休克患者共78例,将患者分为试验组40例与对照组38例,试验组采用集束化治疗,对照组采用传统经验性治疗。比较两组患者的临床疗效。结果治疗24h后,试验组患者的乳酸水平、动脉血氧饱和度(SaO2)、每h平均尿量、平均中心静脉压均优于对照组(P<0.05);治疗3d后,试验组患者急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)及序贯性器官衰竭评分(SOFA)均低于治疗前及对照组治疗后(P<0.05);连续治疗1个月后,试验组患者治疗有效率为92.5%,高于对照组的76.3%(P<0.05)。结论应用集束化治疗胃肠手术后严重感染合并感染性休克患者,可降低患者乳酸水平、动脉血氧饱和度及排尿量,降低患者死亡率,是一种较为安全有效的治疗方法。OBJECTIVE To investigate the clinical efficacy of bundle therapy in patients with severe infections and septic shock after gastrointestinal surgery.METHODS A total of 78 patients with severe infections and septic shock after gastrointestinal surgery from Jan.2013 to Jan.2016 were selected,and were randomly divided into observation group（40 cases）and control group（38 cases）.Patients in observation group were received bundle therapy,and in control group were treated with the traditional empirical treatment.The curative effects of the two groups were compared.RESULTS After 24 hof treatment,the lactic acid level,arterial oxygen saturation（SaO2）,average amount of urine per h and mean central venous pressure of observation group of patients were significantly better than those of control group（P〈0.05）.After 3 days of treatment,the APACHE Ⅱ and SOFA scores in observation group were lower than those before treatment and in control group（P〈0.05）.After 1 month of continuous treatment,the effective rate of observation group was 92.5%,which was higher than 76.3% of control group（P〈0.05）.CONCLUSION Application of bundle therapy in the treatment of severe infection in patients with septic shock after gastrointestinal surgery,can significantly reduce lactic acid level,arterial oxygen saturation and urine volume,and reduce the mortality of patients,which is a safe and effective treatment method.

关 键 词：胃肠手术 严重感染 感染性休克 集束化治疗 临床效果 

分 类 号：R619.3[医药卫生—外科学]