脓毒症集束化治疗对患者预后的影响及其实施现状  

Impact of bundle therapy for sepsis on patient prognosis and its current implementation status

作　　者：丁一凡 李晓青[1] 李雪珠 陈管洁 潘陈伟 杨毅[1] 黄英姿[1] 谢剑锋[1] Ding Yifan;Li Xiaoqing;Li Xuezhu;Chen Guanjie;Pan Chenwei;Yang Yi;Huang Yingzi;Xie Jianfeng(Intensive Care Unit,Zhongda Hospital,Southeast University,Nanjing 210000,China)

机构地区：[1]东南大学附属中大医院重症医学科,南京210000

出　　处：《中华医学杂志》2025年第11期820-826,共7页National Medical Journal of China

基　　金：东南大学附属中大医院护理科研基金项目(KJZC-HL-202321);江苏省级重点研发计划(社会发展)专项资金项目(BE2021734)。

摘　　要：目的探究脓毒症1 h集束化治疗完成率与脓毒症或脓毒性休克患者预后的相关性并调查重症监护病房(ICU)医护人员对脓毒症集束化治疗的认知及实施现状。方法回顾性分析2020年1月至2024年1月东南大学附属中大医院重症医学科脓毒症或脓毒性休克患者的病历资料,以是否完成集束化治疗将患者分为2组,分析是否完成脓毒症集束化治疗与患者28 d病死率的相关性;于2023年8月3至20日采用问卷星形式调查我国ICU医护人员对脓毒症集束化治疗的认知及实施现状。结果共712例脓毒症或脓毒性休克患者纳入分析,其中男470例,女242例,年龄(66.92±16.36)岁。其中575例(80.8%)为完成集束化治疗组,137例(19.2%)为未完成集束化治疗组。与完成组相比,未完成组在年龄、性别和疾病程度方面差异无统计学意义(均P>0.05),但完成组28 d病死率低于未完成组[28.7%(165/575)比39.4%(54/137),P=0.015]。完成集束化治疗与脓毒症或脓毒性休克患者的低死亡风险相关(OR=0.358,95%CI:0.216~0.595)。问卷部分来自全国32个省市自治区,680家医院,1339名ICU医护参与调查,有效问卷占比99.0%(1325/1339)。其中92.5%(1226/1325)的ICU医护认为掌握了脓毒症集束化治疗诊断标准和治疗措施,但实际仅有25.2%(334/1325)ICU医护能够完全掌握相关知识。受调查的ICU医护对于提升脓毒症集束治疗完成率的建议聚焦于相关知识培训86.6%(1148/1325)、质量监督与反馈79.8%(1057/1325)以及改进信息化抓取数据72.2%(957/1325)。结论脓毒症集束化治疗完成率与脓毒症或脓毒性休克患者的28 d病死率相关,ICU医护对脓毒症集束化治疗掌握程度并不理想。Objective:To investigate the correlation between the completion rate of sepsis 1-hour bundle therapy and the prognosis of patients with sepsis or septic shock,as well as to survey the awareness and implementation status of sepsis bundle therapy among medical staff in intensive care unit(ICU).Methods:The medical records of patients with sepsis or septic shock admitted to the Department of Critical Care Medicine of Zhongda Hospital,Southeast University from January 2020 to January 2024 were analyzed retrospectively.The patients were divided into two groups based on whether the bundle therapy was completed.The correlation between the completion of sepsis bundle therapy and the 28-day mortality rate of patients was analyzed.From August 3 to 20,2023,a survey on the awareness and implementation status of sepsis bundle therapy among ICU medical staff in China was conducted using the WJX(Questionnaire Star)form.Results:A total of 712 patients with sepsis or septic shock were included in the analysis,comprising 470 males and 242 females,with a mean age of(66.92±16.36)years.Among them,575(80.8%)were in the bundle therapy completion group,and 137(19.2%)were in the non-completion group.There were no statistically significant differences in age,gender,and disease severity between the two groups(P>0.05).However,the 28-day mortality rate was lower in the completion group compared to that in the non-completion group(28.7%vs 39.4%,P=0.015).Completion of bundle therapy was associated with a lower mortality risk in patients with sepsis or septic shock(OR=0.358,95%CI:0.216-0.595).The survey part included 1339 ICU medical staff from 680 hospitals across 32 provinces,autonomous regions,and municipalities in China,with a valid response rate of 99.0%(1325/1339).Among them,92.5%(1226/1325)of the ICU medical staff claimed to have mastered the diagnostic criteria and treatment measures of sepsis bundle therapy,but in reality,only 25.2%(334/1,325)of the ICU medical staff could fully grasp the relevant knowledge.The surveyed ICU medical sta

关 键 词：脓毒症 1 h集束化治疗 脓毒性休克 质量控制 

分 类 号：R47[医药卫生—护理学]