摘要
目的分析基层医院早期进行积极和规范化治疗对脓毒症患者临床结局的影响.方法回顾性分析2015年1月1日至2018年12月31日入住独山子人民医院重症医学科(ICU)脓毒症患者的临床资料.2015年1月至12月纳入的脓毒症患者采取普通治疗方案,即未规范化治疗脓毒症,仅根据医生经验常规性使用抗菌药物、进行液体复苏、检测乳酸等;从2016年开始对收治的脓毒症患者严格按照Sepsis 3.0的指南要求,并且结合本院实际条件进行规范化诊断与治疗,再细分为2016年(即2016年1月至12月)、2017年(即2017年1月至12月)及2018年(即2018年1月至12月)3个时间段.观察4个时间段患者主要临床结局指标28 d病死率;次要临床结局指标ICU住院时间及ICU住院医疗费用.结果最终纳入脓毒症患者66例,其中2015年17例,2016年18例,2017年17例,2018年14例.与2015年比较,2016、2017、2018年3个时间段ICU住院时间均明显缩短(d :17.45±9.09、12.95±5.93、12.14±4.92比20.85±13.45),ICU住院医疗费用明显减少(万元:9.93±5.35、7.22±3.86、5.15±2.88比13.37±14.14,均P<0.05);28 d病死率均明显下降〔16.67%(3/18)、11.76%(2/17)、14.29%(2/14)比35.29%(6/17),均P<0.05〕.结论对脓毒症进行患者早期、规范化的治疗,可以明显降低患者的ICU住院时间及ICU住院医疗费用.
Objective To analyze the effect on clinical outcome of sepsis patients treated by early positive and standardized treatment in primary hospitals.Methods The clinical data of sepsis patients admitted to intensive care unit(ICU)of Dushanzi People's Hospital from January 1,2015 to December 31,2018 were retrospectively analyzed.The sepsis patients were further divided into a control group(from January to December,2015)who received non-standardized treatment of sepsis,only according to doctors'experience,using routine antibiotics,fluid resuscitation,detection of lactic acid,etc.and a study group;from 2016,the patients with sepsis(the study group)received standardized diagnosis and treatment according to the Guidelines of Sepsis 3.0 and the actual conditions of our hospitals,and they were further subdivided into three periods:2016(from January to December,2016),2017(from January to December,2017),and 2018(from January to December,2018)periods.The main clinical outcome indicator of these patients in 4 time periods,28-day mortality,the secondary clinical outcome indicators such as the length of stay in ICU and medical expenses in ICU were observed.Results Sixty-six patients with sepsis were finally enrolled,including 17 cases in 2015,18 cases in 2016,17 cases in 2017 and 14 cases in 2018.Compared with 2015,the length of ICU stay in 2016,2017 and 2018 were significantly shorter(days:17.45±9.09,12.95±5.93,12.14±4.92 vs.20.85±13.45,all P<0.05),and the medical cost of ICU stay were significantly lower(ten thousand yuan:9.93±5.35,7.22±3.86,5.15±2.88 vs.13.37±14.14,all P<0.05);the 28-day mortality was significantly decreased[16.67%(3/18),11.76%(2/17),and 14.29%(2/14)vs.35.3%(6/17),all P<0.05].Conclusion Early standardized treatment for patients with sepsis can significantly reduce the length of stay in ICU and medical expenses in ICU.
作者
陈世明
沈辉
王勇
董双雄
阿曼古丽·麦麦提牙生
戴雪慧
李新宇
Chen Shiming;Shen Hui;Wang Yong;Dong Shuangxiong;Amanguly•Maimetiya;Dai Xuehui;Li Xinyu(Department of Critical Care Medicine,Dushanzi People's Hospital,Karamay 833699,Xinjiang Uygur Autonomous Region,China;Dushanzi People's Hospital,Karamay 833699,Xinjiang Uygur Autonomous Region,China;Department of Critical Care Medicine,the Second Affiliated Hospital of Xi'an Medical College,Xi'an 710000,Shannxi,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2019年第5期520-523,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
新疆维吾尔自治区克拉玛依市医药卫生项目(〔2016〕113号)。
关键词
基层医院
脓毒症
规范化治疗
临床结局
Primary hospital
Sepsis
Standardized Treatment
Clinical outcome
