严重脓毒症和脓毒性休克病人早期集束化治疗依从性对病死率的影响

目的：研究早期集柬化治疗依从性对严重脓毒症和脓毒性休克病人病死率的影响。方法：对2009年10月至2010年12月江门市中心医院收治的62例严重脓毒症和脓毒性休克病人分存活组与死亡组，进行6h、24h集束化治疗依从性评价，了解集束化治疗的依从性及对病人28d病死率的影响。结果：6h集束化治疗中，2h测中心静脉压（74．2％）及液体复苏（56．5％）依从性略低，SevO2监测依从性最低（6．5％）；24h集柬化治疗中，液体复苏依从性略低（74．2％），激素（24．2％）及多巴酚丁胺（20．1％）使用依从性最低，其余指标依从性好。6h、24h集柬化治疗达标率为45．2％及64．5％。死亡组与存活组比较6h、24h集束化治疗达标率均明显降低，并有统计学差异，6h、24h集束化治疗中液体复苏依从性两组比较均有统计学差异，其余无统计学差异。结论：6h、24h集柬化治疗中液体复苏可降低严重脓毒症和脓毒性休克病人的病死率，故为降低重症脓毒症患者死亡率应重点提高液体复苏依从性。

The Influence of the Compliance of Early Bundle Treatment to Mortality of Patients with Severe Sepsis or Septic Shock

Objective ： To study the influence of the compliance of early bundle treatment to mortality of patients with severe sepsis or septic shock. Method： 62 patients with severe sepsis or septic shock from October 2009 to December 2010 in ICU at the central hospital of Jiangmen were divided into two groups （ the death and the alive group）. We evaluated the compliance of 6 hours and 24 hours bundle treatment respectively. To study the influence of the compliance of bundle treatment to 28 days mortality in patients . Result ： In 6 hours bundle treatment, the compliance of 2 hours measure central venous pressure （ 74.2% ） and fluid resuscitation （56.5 %） were slightly lower, the compliance of ScvOa detection was the lowest （6. 5%）. In 24 hours bundle treatment, the corapliance of fluid resuscitation was slightly lower （74.2% ） , hormone （24.2% } and dobutamine （20.1%） were lowest, the rest indexes compliance were good. The success rates of 6 hours and 24 hours bundle treatment were 45.2% and 64.5%. Death group compared with alive group ,6 hours and 24 hours bundle treatment success rates were significantly reduced. There was signifi- cant differences. Both 6h and 24h bundle treatment the compliance of fluid resuscitation in two groups comparisons were statistically significant, and tbe rests were not statistically significant. Conclusion： In 6h and 24h bundle treatment ,fluid resuscitation may reduce the mortality of patients with the severe sepsis and septic shock patients. We should improve the compliance of fluid resuscitation to reduce the mortality of patients with severe sepsis.