集束治疗感染性休克的依从性及其对患者病死率的影响

目的了解临床医师集束治疗感染性休克患者的依从性及其对病死率的影响。方法记录2007年1—12月重症监护病房（ICU）连续收治的58例成人感染性休克患者6h集束治疗目标完成情况，并按是否完成集束治疗分为集束治疗组和未完成集束治疗组，比较2组患者的年龄、性别、感染部位、急性生理学和慢性健康状况评分Ⅱ（APACHEⅡ）、机械通气时间、ICU住院时间以及患者病死率。结果58例患者中，完成6h集束治疗的患者为22例，集束治疗依从性为37．9％（22／58）。与未完成集束治疗组相比，集束治疗组机械通气时间和住院时间明显缩短，差异具有统计学意义（t值分别为-2．225和-3．702，P值分别为0．037和0．001）。集束治疗组患者的病死率明显低于未完成集束治疗组（χ^2=10．236，P=0．000）。结论集束治疗能够降低感染性休克患者的病死率，临床医师应提高集束治疗的依从性。

Compliance with sepsis bundles and its impact on mortality rate in patients with septic shock

Objective To evaluate the compliance of sepsis bundles and its impact on the mortality rate in patients with sepsis shock. Methods Fifty-eight adult patients with sepsis shock admitted in the intensive care units from January to December 2007 were enrolled in the study, and the compliance with the 6-h bundle was analyzed. Age, gender, sites of infection, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score, duration of mechanical ventilation, ICU stay and the mortality rate were compared between patients completed 6-h bundles and those not completed 6-h bundles. Results Compliance with the 6-h bundle was obtained in 22 out of 58 patients （37.9%）. Patients receiving bundle care had shorter duration of mechanical ventilation and shorter length of ICU stay than non-bundle patients （t = - 2. 225 and - 3. 702, P = 0.037 and 0. 001, respectively） , and the mortality rate in 6-h bundle patients was also lower （χ^2 = 10. 236, P =0.000）. Conclusion The application of 6-h bundle care can reduce the mortality rate of the patients with sepsis shock, and the compliance should be improved.