感染性休克的早期多项综合治疗

目的探讨早期多项综合治疗是否可以改善感染性休克患者的预后。方法采用前后对照的临床研究方法。共有33名患者入组。其中有15例患者实施多项综合治疗,另18例患者实施常规治疗,前者为研究组,后者为对照组。根据拯救全身性感染战役(surviving sepsis campaign,SSC)指南,观察早期多项综合治疗(早期目标治疗、早期经验性应用高效广谱抗生素、控制血糖、静脉应用小剂量激素)记录患者一般情况,包括感染性休克时中心静脉压(central venous pressure,CVP),治疗后CVP、治疗前后血液乳酸含量、患者早期的输液量、血糖、ICU住院天数、28d病死率、ICU病死率、出院病死率。结果2组患者入选时的病情差异无统计学意义。研究组在休克后6h内输液量多于对照组,〔(2816.67±1469.41)mLvs(1882.22±1024.63)mL,P=0.040〕。研究组治疗6h后的CVP高于对照组〔(11.2±4.74)mmHgvs(7.35±3.95)mmHg,P=0.018〕。24h后研究组CVP仍高于对照组〔(10.53±2.67)mmHgvs(5.76±1.60)mmHg,P=0.000〕。研究组28d病死率低于对照组(33.7%vs72.2%,P=0.038)。研究组有40%患者应用小剂量激素,对照组未应用激素。2组患者前3d血糖、ICU病死率、住院病死率差异无统计学意义。结论早期多项综合治疗可以更好的改善感染性休克患者的预后。

The Therapeutic Efficacy of "Sepsis Bundle"in Patients with Septic Shock

Objective The purpose of this study is to observe if the early bundle therapy can improve the outcome in patients with septic shock.Methods Thirty-three patients with septic shock in ICU of Fuxing Hospital from 2004 to 2007 have been enrolled, they were divided into two groups at the cut-point of Jan 1st 2006. The 15 patients from Jan 1st 2006 to Mar 1st 2007 were treated with the bundle therapy as a study group, the other 18 patients from Nov 1st 2004 to Jan 1st 2006 were given the routine therapy as a control group. According to the surviving sepsis campaign(SSC)guideline, the bundle therapy included the following: early goal-directed therapy (EGDT), early(within 1 hour after diagnosis) empirical use of broad-spectrum and effective antibiotics, blood glucose control, small-dose intravenous corticosteroid. The baseline data such as age, gender, acute physiology and chronic health evaluation(APACHE Ⅱ), sepsis-related organ failure assessment(SOFA), the initial central venous pressure(CVP), and CVP monitor changes before and after therapy, the changes in arterial serum lactate concentration, early volume intate, blood glucose changes, the length of ICU stay, 28-day hospital mortality, ICU mortality, in hospital mortality were recorded and compared with the control group.Results There were no differences in age, APACHEⅡand SOFA between two groups. Patients treated with the bundle therapy received more fluid within the first 6 hours(2 816.67±1 469.41 mL vs 1 882.22±1 024.63 mL, P=0.040〕. The CVP was significantly higher in the study group than that in the control group after the first 6 hours' treatment(11.2±4.74 mmHg vs 7.35±3.95 mmHg, P=0.018) and after 24 hours' treatment(10.53±2.67 mmHg vs 5.76±1.60 mmHg, P=0.000). The 28-day hospital mortality in the study group was significantly lower than that in the control group(33.7% vs 72.2%, P=0.038) . There were no significant differences in the first 3 day blood glucose between the two groups. There were no significant difference in ICU mortality and hospital mortality in the two groups.Conclusion Patients treated with early bundle therapy in the study group have given more active fluid resuscitation than those in the control group within the first 6 hours of septic shock, and 28-day hospital mortality in the study group is significantly decreased. Sepsis bundle may improve prognosis of patients with septic shock.