脓毒性休克快速反应小组对1 h集束化治疗策略实施依从性的影响  

Effect of septic shock rapid response group on compliance with hour-1 bundle therapy strategy

作　　者：郑鹏[1] 高志伟 孙青松[1] 徐亮[1] 谢守祥 赵红梅[1] 孙虹[1] 甄洁 Zheng Peng;Gao Zhiwei;Sun Qingsong;Xu Liang;Xie Shouxiang;Zhao Hongmei;Sun Hong;Zhen Jie(Department of Emergency,Huai'an First People's Hospital,Huai'an 223300,China;Department of infectious diseases,Huai'an First People's Hospital,Huai'an 223300,China)

机构地区：[1]淮安市第一人民医院急诊科,淮安223300 [2]淮安市第一人民医院感染性疾病科,淮安223300

出　　处：《中华急诊医学杂志》2022年第11期1457-1462,共6页Chinese Journal of Emergency Medicine

基　　金：2019年度淮安市卫生健康科研立项项目(HAWJ201905)。

摘　　要：目的评估脓毒性休克快速反应小组(septic shock rapid response team,SSRRT)对急诊脓毒性休克患者1 h集束化治疗策略实施依从性以及预后的影响。方法研究选取2020年1月至2021年12月至南京医科大学附属淮安第一医院就诊的急诊脓毒性休克患者。入选标准:符合拯救脓毒症运动国际指南Sepsis 3.0诊断标准急诊脓毒性休克患者,排除标准:年龄<18岁、妊娠患者、外院转入已接受液体复苏和(或)血管活性药物患者、需急诊手术者、急诊滞留时间<1 h者、拒绝放置中心静脉置管或有置管禁忌证患者和拒绝知情同意。2021年1月建立SSRRT,根据SSRRT建立前后分为SSRRT实施前组和SSRRT实施后组。收集患者一般临床资料,诊断脓毒性休克时生命体征、乳酸、液体复苏量、血管活性药物最大泵入速度,1 h集束化治疗策略实施情况以及ICU和28 d病死率。采用SPSS 25.0统计软件,分类变量组间比较采用Pearsonχ^(2)检验,连续变量组间比较采用Mann-Whitney U检验。结果研究期间共有289例急诊患者符合纳入标准,根据排除标准排除115例,最终纳入174例,其中SSRRT实施前组83例,SSRRT实施后组91例。与SSRRT实施前组相比,SSRRT实施后组患者监测乳酸(54.2%vs.100.0%,P<0.001)、留取血培养(27.7%vs.93.4%,P<0.001)、使用抗生素(57.8%vs.97.8%,P<0.001)、快速液体复苏量≥30 mL/kg(4.8%vs.34.1%,P<0.001)以及平均动脉压≥65 mmHg(49.4%vs.68.1%,P<0.001)例数均明显增加。两组间患者ICU病死率(50.6%vs.37.4%,P=0.079)以及28 d病死率(53.0%vs.38.5%,P=0.054)差异无统计学意义。结论脓毒性休克快速反应小组可显著提高急诊脓毒性休克患者1 h集束化治疗策略实施依从性,并有降低病死率趋势。Objective To investigate the effect of septic shock rapid response team(SSRRT)on the compliance and prognosis of hour-1 bundle therapy strategy in emergency department patients with septic shock.Methods This study was conducted on emergency patients with septic shock who were admitted to Huai’an First Hospital Affiliated to Nanjing Medical University from January 2020 to December 2021.The inclusion criteria were emergency patients with septic shock who met the international guideline for surviving sepsis campaigns(Sepsis 3.0).Exclusion criteria:age<18 years,pregnant patients,patients transferred from another hospital who had received fluid resuscitation and/or vasoactive drugs,patients requiring emergency surgery,patients with emergency detention time<1 h,patients who refused to place central venous catheterization or had contraindications for catheterization,and patients who refused to give informed consent.SSRRT was established in January 2021.According to the establishment of SSRRT,patients were divided into the pre-SSRRT intervention group and the post-SSRRT intervention group.The general clinical data of the enrolled patients were collected,including vital signs,lactate,fluid resuscitation volume,maximum vasoactive drug pumping rate at the diagnosis of septic shock,implementation of hour-1 bundle therapy strategies,and ICU and 28-day mortality.Statistical software SPSS 25.0 was used.Pearson chi-squared test was used to compare categorical variables between groups,and Mann-Whitney U test was used to compare continuous variables between groups.Results A total of 289 emergency patients met the inclusion criteria,115 patients were excluded,and 174 patients were eventually included,including 83 patients in the pre-SSRRT group and 91 patients in the post-SSRRT group.Compared with the pre-SSRRT group,the proportion of lactate monitoring(54.2%vs.100.0%,P<0.001),blood culture(27.7%vs.93.4%,P<0.001),antibiotics(57.8%vs.97.8%,P<0.001),fluid resuscitation volume≥30 mL/kg(4.8%vs.34.1%,P<0.001),and mean arterial press

关 键 词：休克 脓毒性 快速反应小组 1 h集束化治疗策略 急救医疗服务 依从性 

分 类 号：R459.7[医药卫生—急诊医学]