感染性休克集束治疗对病死率影响的前瞻性临床研究

目的 探讨集束治疗对感染性休克患者病死率的影响.方法 采用前瞻性研究方法,将2007年1月-2008年6月重症加强治疗病房(ICU)收治的成人感染性休克患者分为培训前(2007年1-9月)和培训后(2007年10月-2008年6月)两个阶段进行感染性休克集束治疗.分析6 h及24 h感染性休克集柬治疗各指标与预后的关系;采用多元回归分析方法,筛选出集束治疗对感染性休克预后影响的独立相关因素,并研究两个阶段感染性休克集束治疗的依从性、机械通气时间、ICU住院时间以及28 d病死率.结果 研究期间共收治符合条件的感染性休克患者100例,其中培训前51例,培训后49例;存活36例,死亡64例.多元回归分析显示,6 h早期目标导向治疗(EGDT)、24 h EGDT是与感染性休克28 d病死率相关的两个独立保护因素,优势比(OR)分别为0.046和0.120(P均<0.01).培训后集束治疗依从性均有明显提高,其中6 h EGDT和24 h EGDT分别从19.6%、35.3%提升至55.1%、65.3%(P均<0.01).培训后机械通气时间(166.6±156.4)h比(113.6±73.6)h3、ICU住院时间(9.4±7.6)d比(6.0±3.9)d]及28 d病死率(72.5%比55.1%)较培训前明显缩短(P<0.05或P<0.01).结论 继续教育培训可提高医务人员对感染性休克集束治疗的依从性,降低感染性休克患者的病死率.

The impact of sepsis bundles on mortality in patients with sepsis shock: a prospective clinical study

OBJECTIVE: To survey the impact of sepsis bundle on prognosis of septic shock. METHODS: From January 2007 to June 2008, a prospective clinical study was conducted on consecutive adult patients with sepsis shock in intensive care unit (ICU). The study of sepsis bundle on septic shock was divided into before training (from January to September 2007) and trained phases (from October 2007 to June 2008), and the patients were divided into control group and death group. The relationship between sepsis bundle index and prognosis at 6 hours and 24 hours was analyzed with logistic regression analysis. The independent factors of death due to septic shock were looked for. The compliance of sepsis bundles, duration of mechanical ventilation (MV), ICU stay, and 28-day mortality were noted. RESULTS: One hundred patients, including 51 patients before training and 49 patients after training were enrolled for study. Thirty-six patients survived and 64 patients died. All the patients met the criteria for the diagnosis of sepsis shock. Through analysis of the parameters with logistic regression, it could be found that 6-hour early goal-directed therapy (EGDT) and 24-hour EGDT were the two independent protective factors of death, and standardized regression coefficient was 0.046 and 0.120 respectively (both P<0.01). Compliance with sepsis bundles was low in training phase, the compliance incresed apparently after training. Among them, 6-hour EGDT and 24-hour EGDT compliance increased to 55.1%, 65.3% from 19.6%, 35.3% (both P<0.01). Compared with the group before training, the duration of MV (166.6+/-156.4) hours vs. (113.6+/-73.6) hours], that of ICU stay (9.4+/-7.6) days vs. (6.0+/-3.9) days] and 28-day mortality (72.5% vs. 55.1%, P<0.05 or P<0.01) was significantly lower after training. CONCLUSION: Sepsis bundle is able to improve survival rate in patients in septic shock. Compliance with sepsis bundles is low before training, and training can improve the compliance and decrease mortality rate of septic shock.