早期集束化治疗对脓毒症及脓毒性休克患者预后的影响  

Effect of early bundle therapy on prognosis of patients with sepsis and septic shock

作　　者：季兵[1] 朱建良[1] 马丽梅 袁慧琴 贾星宇 刘励军[1] 朱建军[1] Ji Bing;Zhu Jianliang;Ma Limei;Yuan Huiqin;Jia Xingyu;Liu Lijun;Zhu Jianjun(Department of Emergency,the Second Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第二医院急诊科,215000

出　　处：《中华急诊医学杂志》2019年第2期170-174,共5页Chinese Journal of Emergency Medicine

摘　　要：目的观察脓毒症/脓毒性休克患者实施早期集束化治疗对病死率的影响,分析影响死亡的危险因素。方法采用回顾性队列研究方法,选择2016年1月至2016年12月苏州大学附属第二医院重症监护病房(ICU)脓毒症/脓毒性休克患者,按治疗后28d预后情况分为生存组及死亡组两组,比较两组患者的一般基线资料,入院时及治疗后早期集束化治疗指标,病程中脏器功能衰竭数目等的差异,通过logistic回归分析筛选死亡的独立危险因素。结果118例脓毒症/脓毒性休克患者中,28d病死率为32.2%。与生存组相比,死亡组患者既往心功能不全、脑血管意外、乳酸清除率、6h集束化治疗达标率、病程中出现1个和>2个脏器功能衰竭存在统计学意义(P<0.05);年龄、入院时血白细胞(WBC)、血尿素氮(BUN)、血肌酐(Cr)、血脑钠肽(BNP)、序贯器官衰竭评分(SOFA)、急性生理与慢性健康评分Ⅱ(APACHEⅡ)、集束化治疗后乳酸水平较生存组明显增高(P<0.05)。Logistic回归分析显示:年龄(≥75岁)(OR=1.012)、6h后乳酸清除率<30%(OR=1.122)、慢性心衰(OR=1.741)、>2个器官功能障碍(OR=1.769)、6h集束化治疗未达标(OR=1.985)是脓毒症/脓毒性休克患者死亡的独立影响因素。结论对于脓毒症/脓毒性休克患者需尽早诊断和复苏治疗,提高集束化治疗达标率,进而降低脓毒症/脓毒性休克患者的病死率。Objective To observe the effect of early bundle therapy on prognosis of patients with sepsis/septic shock and analyze the risk factors for death.MethodsA retrospective cohort study was conducted to select patients with sepsis/septic shock at the Second Soochow University Hospital between January 1,2016,and December 31,2016.Data pertaining to demographic variables,compliance rate of bundle therapy,and incidence of organ failure were collected.Patients were categorized into the non-survivor or survivor groups based on 28-day mortality.Logistic regression analysis was used to identify risk factors for 28-day mortality.ResultsTotally 118 sepsis/septic shock patients were included in the analysis;28-day mortality was 32.2%.Compared to the survivor group,patients in the non-survivor group were more likely to have chronic heart dysfunction and cerebrovascular disease,lower lactate clearance,lower 6-h compliance rate of bundle therapy and higher incidence of failure of one or>2 organs.Age,leukocyte,blood urea nitrogen,creatinine,brain natriuretic peptide,sequential organ failure score and acute physiological and chronic health scores Ⅱ on admission,and lactate after bundle therapy were higher than that of the survivor group.Logistical regression analysis showed that age≥75 years[odds ratio(OR)1.012],6-h lactate clearance<30%(OR=1.122),chronic heart failure(OR=1.741),failure of>2 organs(OR=1.769),and 6-h compliance rate of bundle therapy(OR=1.958)were independent risk factors for 28-day mortality.ConclusionsPatients with sepsis/septic shock need early diagnosis and resuscitation to improve the compliance rate of bundle therapy and reduce the mortality.

关 键 词：脓毒症/脓毒性休克 集束化治疗 乳酸清除率 序贯器官衰竭评分 液体复苏 

分 类 号：R459.7[医药卫生—急诊医学]