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早期目标导向治疗在感染性休克中应用的临床探讨
引用本文:何征宇,皋源,王祥瑞,杭燕南.早期目标导向治疗在感染性休克中应用的临床探讨[J].中国危重病急救医学,2007,19(1):14-16.
作者姓名:何征宇  皋源  王祥瑞  杭燕南
作者单位:200127,上海交通大学医学院附属仁济医院麻醉科
基金项目:上海市卫生局百人计划基金资助项目(03-77-20)
摘    要:目的观察“早期目标导向治疗”(EGDT)对感染性休克的临床效果。方法将203例感染性休克患者根据接受治疗的手段分为治疗组(n=98)和对照组(n=105),同时根据治疗开始时患者器官功能的情况,按多器官功能障碍综合征(MODS)评分标准将两组患者进一步分为器官功能轻度受损(A层)、中度受损(B层)和重度受损(C层),分别比较两组患者的病死率及器官衰竭发生率。结果治疗组A、B和C层患者的病死率分别为27.78%(15/54例)、75.86%(22/29例)和93.33%(14/15例),器官衰竭发生率分别为31.48%(17/54例)、55.17%(16/29例)和40.00%(6/15例);对照组A、B和C层患者的病死率分别为37.50%(18/48例)、76.92%(20/26例)和96.77%(30/31例)。器官衰竭发生率分别为43.75%(21/48例)、57.69%(15/26例)和41.93%(13/31例)。两组患者的病死率和器官衰竭发生率在A层水平上差异均有显著性(P均<0.05),而在B层和C层水平上差异均无显著性(P均>0.05)。结论EGDT能显著降低感染性休克早期患者的病死率与器官衰竭发生率,但不能相应改善感染性休克中、晚期患者的生存和预后情况。

关 键 词:休克  感染性  早期目标导向治疗  病死率  多器官功能障碍综合征
收稿时间:2006-10-26

Clinical evaluation of execution of early goal directed therapy in septic shock
HE Zheng-yu,GAO Yuan,WANG Xiang-rui,HANG Yan-nan.Clinical evaluation of execution of early goal directed therapy in septic shock[J].Chinese Critical Care Medicine,2007,19(1):14-16.
Authors:HE Zheng-yu  GAO Yuan  WANG Xiang-rui  HANG Yan-nan
Institution:Department of Anesthesiology, Renji Hospital, Medical College of Shanghai Jiaotong University, Shanghai 200127, China.
Abstract:OBJECTIVE: To evaluate the efficacy of early goal directed therapy (EGDT) in septic shock. METHODS: Two hundred and three patients with septic shock were assigned into treatment group (n=98) and control group (n=105). According to the state of organ function at the beginning of treatment and multiple organ dysfunction syndrome (MODS) evaluation scores, each group was categorized into three strata: stratum A (mild organ dysfunction), stratum B (medium organ dysfunction) and stratum C (severe organ dysfunction). Mortality and incidence of organ dysfunction in each group were analyzed. RESULTS: At stratum A, the mortality and incidence of organ dysfunction in treatment group were significantly lower than those of control group 27.78% (15/54 cases) vs. 37.50% (18/48 cases), 31.48% (17/54 cases) vs. 43.75% (21/48 cases), both P<0.05]. There was no significant difference between treatment group and control group in patients of stratum B 75.86% (22/29 cases) vs. 76.92% (20/26 cases), 55.17% (16/29 cases) vs. 57.69% (15/26 cases)] and stratum C 93.33% (14/15 cases) vs. 96.77% (30/31 cases), 40.00 % (6/15 cases) vs. 41.93% (13/31 cases), all P>0.05]. CONCLUSION: In the earlier period of septic shock, EGDT can remarkably decrease the patients'mortality and incidence of organ dysfunction, but can not improve survival rate and prognosis in patients in advanced stage of septic shock.
Keywords:septic shock  early goal directed therapy  mortality  multiple organ dysfunctionsyndrome
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