重症肺炎及感染性休克的集束治疗

目的 探讨国内严重感染集束治疗的疗效.方法 在广州医学院附属第二医院呼吸重症监护病房中选用43例重症肺炎及感染性休克患者,进行14个月(2006年11月1日至2007年12月31日)前瞻性观察研究.患者入进标准参照2001年国际脓毒症会议.分教育、试验和运作3个连续阶段实施6 h严重感染集束治疗和24 h严重感染集束治疗.历史对照期内(2004年1月1日至2006年10月31日)合格患者门入对照组.计最资料以(x±s)表示,计数资料以率表爪.采用γ2检验、独立样本t榆验、配对t检验、单因素和多冈素Logistic回归分析,P＜0.05为差异具有统计学意义.结果 1)对照组和集束治疗组问的基础特征差异基本上无统计学意义.2)血清乳酸测定率、休克业组液体复苏率及6 h内所输入液体量、血糖榨制,与对照组相比较,其差异均有统计学意义(P值分别是0.024,0.009,0.045和0.000).3)72 h时,集束治疗组呼吸频率和氧合指数,与对照组相比较,其差异均有统计学意义(P值分别是0.033和0.041);集束治疗组中休克业绀急性生理和慢性疾病评分(A-PACHE)Ⅱ分值和预计死亡率的下降值,与对照组中休克业组比较,其差异均有统计学意义(P值分别是0.017和0.040).4)与对照组比较,集束治疗组病死率绝对值下降23.30%(P=0.019).结论 严重感染集束治疗能显著降低重症肺炎及感染性休克患者病死率.

Effects of sepsis bundles on severe pneumonia and septic shock

Objective To investigate the effects of sepsis bundles in China.Method An observational study of 43 patients with severe pneumonia and septic shock admitted to the respiratory intertive care unit(1/11/2006-31/12/2007)was carried out.The selection criteria were in accordance with criteria set by International Conference On Sepsis in 2001.Implementation of 6 hours and 24 hours sepsis bundles was divided into 3 continu-ous phases consisting of education,trial,and application phase.A cohort of 43 patients with matched disease his-tory(1/1/2004-31/10/2006)was enrolled as control group.The percentages for categorical variables and mean±SD for continuous variables were reported.Chi-Square test.unpaired Student's t -test.paired-samples t test,univariate and multivariate logistic regression models were used.Statistical significance was defined as P＜0.05.Results There were very little significant differences in basic characteristics of patients between the two groups.Compared with control group,the differences in serrum lactate,fluid resuscitation and fluid volume infused within 6 hours and blood glucose control in shock subgroup were significant(P values were 0.024,0.009,0.045,and 0.000,respectively).Compared with control group,the differences in respiratory rate and oxygenation index of bundles group at 72 hours later were significant(P values were 0.033 and 0.041,respectively).Compared with control group,the differences in APACHE Ⅱ score and predicted mortality in shock subgroup of bundles were sig-nificant(P values were 0.017 and 0.040,respectively).Compared with control group,the reduction in absolute mortality was 23.30% in bundles group(P=0.019).Conclusions Implementation of sepsis bundles con-tributes noticeably to the significant reduction in mortality of patients with severe pneumonia and septic shock.