摘要
目的:分析并研究脓毒性休克患者的相关临床特点及液体复苏策略。方法:选取我院急诊科[包含抢救室、重症监护室(EICU)]在2016-01-01—2019-12-31期间收治的符合纳入排除标准的脓毒性休克患者作为研究对象,首先根据临床结局将研究对象分为生存组及死亡组,分析其相关临床特点;然后按液体复苏策略,将研究对象分为白蛋白+晶体液体复苏组和单纯晶体液体复苏组,观察并记录2组患者24 h的输液量、血流动力学恢复指标。结果:①纳入研究的脓毒性休克患者共81例,腹腔感染(37例,45.68%)及肺部感染(21例,25.93%)占绝大多数;死亡16例,病死率为19.75%;其中革兰阴性菌占培养阳性病例数约2/3(67.44%)。②采用白蛋白+晶体复苏组首个24 h输液量明显低于单纯晶体复苏组(P<0.05),其中白蛋白+晶体液体复苏组使用白蛋白量为(45.00±8.51)g;2组患者经过24 h的治疗心率、血乳酸均明显下降,MAP、CVP明显升高;但白蛋白+晶体液体复苏组比单纯晶体复苏组心率、血乳酸明显降低(P<0.05)。结论:脓毒性休克患者病死率高,感染源主要来源于腹腔及肺部,且大多数感染为革兰阴性菌所致。白蛋白+晶体液体复苏可以维持并改善患者的血流动力学指标,减少对机体内环境的影响,有利于脏器功能的恢复。
Objective:To analyze and study the clinical characteristics and fluid resuscitation strategy of patients with septic shock.Method:Eighty-one patients with septic shock admitted to emergency department(including rescue room and intensive care unit)in our hospital,from 0:00:00 on January 1,2016 to 23:59:59 on December 31,2019,were enrolled and divided into survival group(65 cases)and death group(16 cases)to analyze the clinical characteristics of septic shock patients.According to whether the strategy of fluid resuscitation was implemented,the subjects were divided into albumin+crystal fluid resuscitation group and crystal fluid resuscitation group.The patients in the two groups were observed and recorded 24 hours of infusion volume,hemodynamic index recovery index.Result:①A total of 81 patients with septic shock were included in the study.Abdominal infections(37 cases,45.68%)and lung infections(21 cases,25.93%)accounted for the vast majority;16 deaths,the case fatality rate was 19.75%;Gram-negative bacteria about 2/3 of the culture-positive cases(67.44%).②The first 24-hour infusion volume of albumin+crystal group was significantly lower than those of simple crystal resuscitation group(P<0.05),and the albumin volume of albumin+crystal group was(45.00±8.51)g.After treatment for 24 hours,the heart rate and blood lactate of the two groups were significantly decreased.MAP and CVP were significantly increased,but the heart rate and blood lactate of the albumin+crystal group were significantly lower than that of the simple crystal fluid resuscitation group(P<0.05).Conclusion:There was a high mortality in patients with septic shock.The main source of infection was from abdominal cavity and lung,and most of them were caused by gram-negative bacteria.Albumin+crystalcan maintained and improved the hemodynamic indexes of patients,reduced the impact on the internal environment,and was conducive to the recovery of organ function.
作者
魏桂枝
王仙琦
程云会
王莉
王倩梅
王玉同
WEI Guizhi;WANG Xianqi;CHENG Yunhui;WANG Li;WANG Qianmei;WANG Yutong(Department of Emergency,Xijing Hospital,Air Force Medical University,Xi’an,710032)
出处
《临床急诊杂志》
CAS
2020年第8期648-653,共6页
Journal of Clinical Emergency
基金
国家自然科学基金青年科学基金项目(No:81601617)。
