急诊感染性休克患者3h集束化治疗策略临床实施依从性的观察  

Observational Study on the Compliance of 3-Hour Bundle Therapy in Emergency Patients with Septic Shock

作　　者：许梅连 XU Meilian(Department of Critical Care Medicine,The First Hospital of Longyan City,Longyan 364000,China)

机构地区：[1]龙岩市第一医院重症医学科,福建龙岩364000

出　　处：《中华灾害救援医学》2024年第10期1128-1130,共3页Chinese Journal of Disaster Medicine

基　　金：茂名市科技计划项目(220416104550231)。

摘　　要：目的分析3h集束化治疗策略在感染性休克患者具体实施情况。方法选取2023年3月至2024年3月龙岩市第一医院重症医学科收治的100例感染性休克患者为研究对象。分析患者年龄、性别、APACHEⅡ评分,3h集束化治疗策略的临床具体实施情况,患者中心静脉压(Central Venous Pressure,CVP)、平均动脉压(Mean Arterial Pressure,MAP)、尿量、中心静脉血氧饱和度(Central Venous Oxygen Saturation,ScvO_(2))、混合静脉血氧饱和度(Oxygen Saturation of Mixed Venose Blood,SvO_(2))水平,抗菌药物使用时间,早期目标化治疗达标情况,3h集束化治疗对患者28d内病死率的影响。结果3h内均采取了抗生素治疗的实施率达100%(100/100);血乳酸实施率达94.00%(94/100);升压治疗实施率达92.00%(94/100);以上三项治疗实施率>90%,依从性良好。病原菌培养实施率70.00%(70/100);3 h早期目标化治疗的实施率53.00%(53/100);3h集束化治疗的实施率32.00%(32/100);以上三项治疗实施率<80%,依从性较低。CVP达标率为79.00%;SvO_(2)和ScvO_(2)达标率为56.00%;尿量达标率为62.00%;MAP达标率为58.00%;所有目标总达标率为53.00%。完全集束化治疗组研究对象中2例患者28d死亡,病死率为6.25%;未完全集束化治疗组研究对象中18例患者28 d死亡,病死率为26.47%,完全集束化治疗组研究对象的病死率显著低于未完全集束化治疗组(P=0.018)。结论3h集束化治疗可降低感染性休克患者28d的病死率,改善医护人员对集束化治疗实施的依从性,提高3h早期目标化治疗达标率。Objective To analyze the implementation of the 3-hour bundle therapy strategy in emergency patients with septic shock at our hospital.Methods A total of 100 patients with septic shock admitted to the Intensive Care Unit of Longyan First Hospital from March 2023 to March 2024 were selected for this study.We analyzed the patients'age,gender,APACHE II scores,the clinical implementation of the 3-hour bundle therapy strategy,including central venous pressure(CVP),mean arterial pressure(MAP),urine output,central venous oxygen saturation(ScvO_(2)),and mixed venous oxygen saturation(SvO_(2))levels,the timing of antibiotic administration,the achievement of early goal-directed therapy targets,and the impact of the 3-hour bundle therapy on the 28-day mortality rate.Results Within the first 3 hours,the implementation rate of antibiotic therapy was 100%(100/100),blood lactate measurement was 94.00%(94/100),and vasopressor therapy was 92.00%(92/100),all with compliance rates exceeding 90%,indicating good adherence.The implementation rate of pathogen culture was 70.00%(70/100),early goal-directed therapy within 3 hours was 53.00%(53/100),and the overall 3-hour bundle therapy implementation rate was 32.00%(32/100),all with compliance rates below 80%,indicating lower adherence.The target achievement rates were as follows:CVP at 79.00%,SvO_(2)and ScvO_(2)at 56.00%,urine output at 62.00%,and MAP at 58.00%.The overall target achievement rate was 53.00%.In the complete bundle therapy group,2 patients died within 28 days,with a mortality rate of 6.25%,while in the incomplete bundle therapy group,18 patients died within 28 days,with a mortality rate of 26.47%.The mortality rate in the complete bundle therapy group was significantly lower than that in the incomplete bundle therapy group(P=0.018).Conclusion The 3-hour bundle therapy can reduce the 28-day mortality rate of patients with septic shock,improve the adherence of medical staff to the implementation of bundle therapy,and increase the achievement rate of early goal-directed thera

关 键 词：集束化治疗 感染性休克 病死率 

分 类 号：R6314[医药卫生—外科学]