1 h集束化措施在脓毒症患者救治中的应用效果  

Application effect of 1-hour bundle in the treatment of patients with sepsis

作　　者：杨慧[1] 王文杰[1] 李轶[2] 田丽露 景孟娟 胡玉娜 Yang Hui;Wang Wenjie;Li Yi;Tian Lilu;Jing Mengjuan;Hu Yuna(Department of Intensive Care Unit,Henan Provincial People's Hospital,Zhengzhou 450000,Henan,China;College of Nursing and Health,Henan University,Kaifeng 475000,Henan,China)

机构地区：[1]河南省人民医院中心ICU,郑州450000 [2]河南省人民医院检验科,郑州450000

出　　处：《中华危重病急救医学》2019年第9期1087-1090,共4页Chinese Critical Care Medicine

基　　金：河南省医学科技攻关计划项目(SBGJ2018084)。

摘　　要：目的探讨1 h集束化措施在脓毒症患者救治中的实施情况及应用效果。方法采用方便抽样法,选择2018年1月至2019年2月河南省人民医院中心重症加强治疗病房(ICU)收治的102例脓毒症患者为研究对象,其中2018年1月至9月接受3 h和6 h集束化措施的35例患者作为对照组,2018年10月至2019年2月接受1 h集束化措施的67例患者作为观察组。对照组患者按照2012年国际严重脓毒症及脓毒性休克诊疗指南,采用3 h和6 h集束化措施处理;观察组则按照2018年"拯救脓毒症运动"(SSC)指南,采用1 h集束化措施对患者进行治疗和护理,组建脓毒症集束化治疗医护团队,对团队人员进行相关知识培训,共同商讨1 h内执行项目中可能遇到的阻碍因素并提出可行性对策。记录观察组患者1 h集束化措施达标情况;收集两组患者一般资料〔包括性别、年龄、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)等〕和结局指标(机械通气时间、ICU住院时间、28 d病死率)。结果观察组接受1 h集束化措施的67例患者中有37例1 h集束化措施达标,整体达标率为55.2%(37/67)。37例达标患者中,1 h集束化措施培训前有5例,仅占同期接受1 h集束化措施15例患者的33.3%(5/15);随培训时间延长,1 h脓毒症集束化措施达标率逐渐升高〔培训1周、4周达标率分别为40.0%(4/10)、52.4%(11/21)〕,培训12周时达标患者17例,达标率提高到81.0%(17/21)。选择37例1 h集束化措施达标者与对照组进行比较,结果显示,两组患者的性别、年龄、APACHEⅡ评分等一般资料差异无统计学意义。与对照组比较,观察组患者机械通气时间和ICU住院时间均明显缩短(d:6.15±0.49比7.24±0.53,d:8.21±1.49比9.51±1.92),28 d病死率明显下降〔10.8%(4/37)比31.4%(11/35)〕,差异均有统计学意义(均P<0.05)。结论通过团队协作共同商讨并逐步改进,可明显提高脓毒症1 h集束化措施达标率;采用脓毒症1 h集束化措施�Objective To investigate the implementation and application effect of 1-hour bundle in the treatment of patients with sepsis.Methods A convenient sampling method was conducted.102 patients with sepsis admitted to central intensive care unit(ICU)of Henan Provincial People's Hospital from January 2018 to February 2019 were enrolled.Thirty-five patients with 3-hour and 6-hour bundle from January to September in 2018 were served as the control group,and 67 patients who received 1-hour bundle from October 2018 to February 2019 were served as the observation group.The patients in the control group was treated with 3-hour and 6-hour bundle according to 2012 international guidelines for the diagnosis and treatment of severe sepsis and septic shock;and those in the observation group were treated and nursed according to the 1-hour bundle published by Surviving Sepsis Campaign(SSC)update 2018,and the sepsis cluster treatment medical team was established.The team members were trained in relevant knowledge and discussed the possible obstacles within the team and propose feasible measures.The implementation of the 1-hour bundle in the observation group was recorded.The general data of the patients in both groups including gender,age,acute physiology and chronic health evaluationⅡ(APACHEⅡ),etc.were collected,and the outcome indicators[duration of mechanical ventilation,length of ICU stay,28-day mortality]were observed.Results In the observation group,37 of 67 patients receiving 1-hour bundle met the target,with the overall achievement rate of 55.2%(37/67).Of the 37 eligible patients,5 patients receiving 1-hour bundle met the target before the training of 1-hour bundle,accounting for only 33.3%(5/15)of the 15 patients who received 1-hour bundle during the same period.With the extension of training time,the achievement rate of sepsis 1-hour bundle was gradually increased[the achievement rate at 1 week and 4 weeks of training was 40.0%(4/10)and 52.4%(11/21),respectively],and increased to 81.0%(17/21)at the end of 12 weeks trai

关 键 词：1h集束化措施 脓毒症 护理 

分 类 号：R47[医药卫生—护理学]