以集束化治疗为核心的临床路径在感染性休克患者中的应用

目的 评价我院自制的以集束化治疗为核心的表格式的临床路径在感染性休克患者中的应用效果.方法 选择我院2009年2月1日至2010年2月28日为前瞻性观察期,由急诊科收治ICU的50例感染性休克患者为临床路径组,分路径制定、宣传教育和方案实施3个阶段,实施6h和24 h感染性休克集束化治疗治疗.选择2008年1月1日至2009年1月31日由急诊科收治ICU的47例感染性休克患者作为历史对照组.结果 ①6h内复苏集束化治疗中:与历史对照组比较,临床路径组在入急诊科后初步确诊时间、血清乳酸测定率、抗生素治疗前获取血培养的实施率、1h内给予经验性抗生素治疗、2h内置人中心静脉导管、应用血管活性药物、6hEGDT达标率差异均有统计学意义.②24 h内管理集束化治疗中:临床路径组在小剂量糖皮质激素使用率、血糖控制、保护性肺通气策略上与历史对照组比较差异均有统计学意义(P＜0.05).③与历史对照组比较,路径治疗组的机械通气时间和入住ICU的时间差异无统计学意义(P＞0.05),但病死率绝对值下降了22％ (44％:22％,p=-0.030).结论 实施以6h和24h集束化治疗为核心的临床路径,一方面可以提高急诊科和ICU医师对SSC指南的依从性和可操作性,另一方面也大大降低了严重感染和感染性休克患者的病死率.

Clinical effect of bundle treatment through clinical pathway in the treatment of patients with septic shock

Objective To investigate the effect of sepsis bundles in the management of septic shock through clinical pathway.Methods Fifty patients with septic shock admitted into ICU from emergency room during February 1,2009 to February 28,2010 were enrolled as the clinical pathway group,which were treated by 6-hour and 24-hour bundle treatment.47 patients with matched disease history admitted from January 1,2008 to January 31,2009 were enrolled as the control group.Results ① In 6-hour bundle treatment,statistically significant difference was found in diagnosis time,serum lactate measured,blood culture,antibiotics administration within 1 hour,central catheter inserted within 2 hours,vasopressors received and EGDT achieved within 6 hours between the two groups.② In 24-hour bundle treatment,statistically significant differences was found in low-dose steroids received,blood glucose control and lung-prtective ventilation strategy administered between the two groups.③ No statistically significant difference was found in the ventilation time and the days in ICU between the two groups(P>0.05).As compared with the control group,a 22% absolute mortality reduction was found in the clinical pathway group(22% vs 44%,P=0.030).Conclusion Implementation of sepsis bundles through clinical pathway not only improves the compliance of SSC guidelines,but also reduce the mortality of patients with septic shock.