摘要
回顾分析2013年1月至2015年12月苏北地区三家三级甲等综合性医院重症医学科372感染性休克患者的临床资料，其中生存组（211例）和死亡组（161例）。按照早期目标导向治疗实施情况，分为集束组（117例，行集束治疗，其中30例7项目标均达标、87例未达标）、对照组（255例，未行集束治疗）。经logistic多元回归分析显示，ICU住院时间、衰竭器官数目、抗菌药物首次使用时间是影响感染性休克患者预后的独立危险因素（P〈0．05）。集束组病死率（46．2％）与对照组（42．0％）比较差异无统计学意义（P〉0．05），但集束达标组病死率（20．O％）明显低于集束未达标组（55．2％）与对照组（42．0％）（P〈0．05）。生存时间曲线分析显示集束达标组（中位生存期19．4d）生存时间明显高于对照组（中位生存期10．5d）（P〈0．05），明显高于对照组＋集束未达标组（12．9d）（P〈0．05）。多元回归分析显示，中心静脉血氧饱和度及1h内抗菌药物使用达标是集束治疗降低感染性休克病死率的主要因素（P〈0．05）。提示，感染性休克患者集束治疗各项指标均达标能明显降低感染性休克病死率；1h内抗菌药物使用是集束治疗降低感染性休克病死率的主要因素之一。
The clinical data of 372 patients with septic shock admitted in departments of critical care medicine of three Grade A tertiary hospitals from January 2013 to December 2015 were retrospectively reviewed, including 211 survival cases and 161 fatal cases. According to septic shock early goal-directed therapy implementation, 117 patients received bundle therapy （bundle group）, including 30 eases with bundle goal-fully achieved, and 87 cases with bundle goal-partly achieved; and 255 cases received conventional treatment （non-bundle group）. Muhiple logistic regression analysis showed that the multiple organ dysfunction syndrome score, length of ICU stay and first time using of antibiotics were independent risk factors for prognosis of septic shock （ P 〈 0.05 ）. There was no significant difference in case fatality rate between bundle group and non-bundle group （ 46. 2% vs. 42. 0%, P 〉 0. 05 ）, while the fatality in bundle goal-fully achieved group （20.0%）was significantly lower than that of goal-partly achieved group （55.2%） and non-bundle group （42. 0% ） （P 〈0. 05）. Survival curve analysis showed that the medial survival time in bundle goal-fully achieved group was significantly higher than that in non-bundle group （ 19.4 vs. 10. 5 days, P 〈0.05） and that in control group plus goal-partly achieved group（ 19.4 vs. 12. 9 days, P 〈0. 05）. Multiple Logistic regression analysis showed that central venous oxygen saturation and antibiotics using within one hour were protective factors for prognosis of septic shock （ P 〈 0. 05 ）. The results indicate that antibiotic bundle treatment of all indicators up to standards could significantly reduce the mortality of septic patients and early antibiotics is important in bundle treatment.
作者
吴晓燕
包磊
刘微丽
叶记录
郑瑞强
Department of Critical Care Medicine;Subei People＇s Hospital;Medical School of Yangzhou University;Yangzhou;China(Wu XY, Bao L, Zheng RQ;Department of Critical Care Medicine, Yangzhou First People＇s Hospital, Yaagzhou 225001, Jiangsu, China （ Liu WL;Department of Critical Care Medicine, Taizhou People＇s Hospital, Taizhou 225003, Jiangsu, China（ Ye JL)
出处
《中华全科医师杂志》
2018年第2期133-135,共3页
Chinese Journal of General Practitioners
关键词
休克
脓毒性
综合治疗
抗菌药
医院死亡率
Shock, septic
Combined modality therapy
Anti-bacterial agents
Hospitalmortality
