简易化集束治疗老年感染性休克患者的疗效探讨  

Effect of simple protocol therapy for elderly patients with septic shock

作　　者：杨倩[1] 王仲 关键[1] Yang Qian;Wang Zhong;Guan Jian(Emergency department, First Hospital of Tsinghua University, Beijing, Chin;Beijing Tsinghua Changgung Hospital, Beifing, Chin)

机构地区：[1]北京华信医院(清华大学第一附属医院)急诊科 [2]北京清华长庚医院

出　　处：《实用休克杂志（中英文）》2018年第2期94-99,共6页Journal of Practical Shock

摘　　要：目的 探讨简易化集束治疗老年感染性休克患者的疗效。方法 2014年1月至2016年12月清华大学第一附属医院急诊病房的老年感染性休克患者42例，年龄80±6岁，所有患者均不实施气管插管和机械通气，采用包括无创心电监测、经外周静脉穿刺置入中心静脉导管（peripherally inserted central venous catheters，PICC）泵入血管活性药物、抗生素和静脉补液在内的简易化集束方法进行治疗，观察患者急性生理学与慢性健康状况评分系统-Ⅱ（acute physiology science and chronic health evaluation-Ⅱ，APACHE-Ⅱ）评分、乳酸浓度、乳酸清除率的变化及死亡率。结果 所有患者治疗后6小时（T=11.111，P〈0.001）、治疗后24小时（T=11.655，P〈0.001）及治疗后72小时（T=11.452，P〈0.001）的APACHE-Ⅱ评分与治疗前相比均显著降低。所有患者治疗后6小时（T=6.661，P〈0.001）、治疗后24小时（T=9.242，P〈0.001）及治疗后72小时（T=11.184，P〈0.001）的乳酸浓度与治疗前相比均显著降低；所有患者治疗后24小时的乳酸清除率与治疗后6小时相比显著升高（T=-5.676，P〈0.001）。患者的院内死亡率、30天死亡率和90天死亡率分别为31.0%、38.1%和45.2%。结论 采用简易化集束法治疗老年感染性休克患者，能够获得较好的疗效和较低的死亡率，为今后感染性休克的治疗提供了更多的选择，也为未来的相关研究提供了更多的方向。Objective To investigate the effect of simple protocol therapy for elderly patients with septic shock. Methods Forty-two elderly patients with septic shock received simple protocol therapy in our emergency ward, age 80±6 years. The simple protocol therapy consists of no mechanical ventilation, noninvasive electrocardiographic monitoring, administering vasopressors via peripherally inserted central venous catheters（PICC）, using of antibiotics and fluid management. Acute physiology science and chronic health evaluation-Ⅱ（APACHE-Ⅱ） scores, lactic concentration, lactate clearance and mortality were retrospectively observed. Results The APACHEⅡscore at 6 hours after treatment （T=11.111, P〈0.001）, 24 hours after treatment （T=11.655, P〈0.001） and 72 hours after treatment （T=11.452, P〈0.001） were significantly decreased comparing with before treatment. The lactic concentration at 6 hours after treatment （T=6.661, P〈0.001）, 24 hours after treatment （T=9.242, P〈0.001） and 72 hours after treatment （T=11.184, P〈0.001） were significantly reduced comparing with before treatment. The lactate clearance at 24 hours after treatment were significantly raised comparing with 6 hours after treatment（T=-5.676, P〈0.001）. The hospital mortality, 30-day mortality and 90-day mortality were 31.0%, 38.1% and 45.2% respectively. Conclusions Simple protocol method as a treatment for elderly patients with septic shock indicated a better effect and a lower mortality than expected, which suggested more therapy options for septic shock and more potential directions for research in the future.

关 键 词：老年患者 感染性休克 简易化集束治疗 

分 类 号：R459.7[医药卫生—急诊医学]