摘要
目的探讨早期目标导向治疗(EGDT)对重度脓毒血症患者血清降钙素原(PCT)水平及预后的影响。方法重度脓毒血症患者58例随机分为EGDT组和对照组各29例。2组均积极控制感染、机械通气等基础治疗,EGDT组采取以早期复苏为中心的综合疗法,对照组采用循环与容量支持等常规治疗。比较分析入院不同时间的血清PCT水平、APACHEⅡ评分,记录EGDT达标时间、7 d急性肾损伤(AKI)、多器官功能衰竭(MODS)的发生率及28 d病死率,并分析各指标间的相关性。结果 2组第3、5、7天PCT水平均低于入院时(P<0.05),入院第3天、5天、7天,EGDT组患者PCT水平均明显低于对照组(P<0.05);EGDT组中≤6 h达标者入院第5天、7天PCT水平明显低于>6 h达标者(P<0.05);EGDT组患者入院7 d APACHEⅡ评分、MODS发生率、7天AKI发病率显著低于对照组(P<0.05);7 d APACHEⅡ评分、MODS发生率、7 d AKI发病率均与PCT呈正相关(r=0.651、0.401、0.395,P<0.05)。结论重度脓毒症患者尽早行EGDT,可快速降低血清PCT水平,改善患者的预后,且与达标时间密切相关。
Objective To investigate the early goal directed therapy （ EGDT） on severe sepsis patients ’ serum calci-toninpeptide（PCT）levels.Methods 58 cases of severe sepsis patients were randomly divided into EGDT group and control group with 29 cases in each group .Both of the 2 groups were received active control of infection , mechanical ventilation and other basic treatment , the EGDT group received early recovery as the key part of the comprehensive treatment , the control group received conventional treatment , such as circulation and capacity support .The different admission time , serum PCT lev-el, APACHE II score, recording rate and 28 day mortality incidence of EGDT standard time , 7 days of acute kidney injury （AKI） and multiple organ failure （MODS） were compared between the two groups , and the correlation among the indexes were analyzed.Results The 2 groups’ 3, 5, 7 days’ PCT levels were lower than the admission （ P 〈0.05）, after 3 days, 5 days, 7 days of admission , EGDT group of patients with PCT levels were significantly lower than those of the control group （P〈0.05）;the EGDT group’s patients who with less than or equal to 6 h standards, when admitted to hospital at 5 days, 7 days, the PCT level was significantly lower than those whose 〉6 h standards （ P 〈0.05）;the EGDT group of patients ’ 7 days’ APACHE II score and MODS incidence, 7 days’ AKI incidence was significantly lower than that of control group （P 〈0.05）;7 days’ APACHE II score and MODS incidence, 7 days AKI incidence rate were positively correlated with PCT （r=0.651, r =0.401, r =0.395, P 〈0.05）.Conclusion Severe sepsis patients should received EGDT as early as possi-ble, it can rapidly reduce serum PCT levels , improve prognosis , and is closely related to the standard time .
出处
《疑难病杂志》
CAS
2015年第9期944-946,共3页
Chinese Journal of Difficult and Complicated Cases
