临床路径对感染性休克患者心肺复苏效果影响的研究

目的探讨临床路径对感染性休克患者心肺复苏效果的影响,为心跳呼吸骤停患者复苏提供一定的临床依据。方法选择2011至2013年于本院实施救治的感染性休克所致心脏骤停的患者共90例为研究对象,其中对照组30例,实施常规救治,观察组60例,实施临床路径救治;比较两组患者的救治程序,包括基础生命支持复苏程序（BLS）和高级生命支持复苏程序（ALS）,以及救治疗效。结果两种复苏方法全部进行胸外按压,差异无统计学意义,其中实施人工呼吸常规方法者27例,占90.0%,临床路径全部实施,差异具有统计学意义（χ^2=4.143,P=0.043）,实施开放通道和置口咽管临床路径均显著高于常规复苏方法,差异具有统计学意义（χ^2=17.244、54.784,P=0.000、0.000）;常规方法对伴有急性肾功能衰竭、急性心功能不全、急性肺功能衰竭及其他疾病患者成功的例数分别为1、1、0和1例,临床路径成功复苏的例数为12、5、2和2例;对治疗伴有急性肾功能衰竭方面,两种方法疗效差异具有统计学意义（χ^2=5.121,P=0.027）;两种方法在伴有急性心功能不全及急性肺功能衰竭方面,具有显著性统计学意义（χ^2=12.070、11.224,P=0.001、0.001）,其他疾病复苏成功率一致;两种方法在立即复苏、5 min以内及5～8 min以内复苏方面比较差异具有统计学意义（χ^2=24.982、10.244、6.772,P=0.000、0.002、0.009）,8 min以上成功率一致,均无复苏成功者。结论按临床路径实施救治能显著提高感染性休克所致心脏骤停的患者复苏成功率。

Study on the effect of clinical pathway in patients with septic shock cardiopulmonary resuscitation

Objective To explore the clinical pathway in patients with septic shock caused by the effects of cardiopulmonary resuscitation（CPR）, to provide clinical basis for patients with cardiopulmonary resuscitation. Methods Total of 90 patient with treatment of septic shock caused by cardiac arrest from 2011 to 2013 in our hospital were sellected, there were 30 cases in control group with the implementation of routine treatment; while 60 cases in observation group with the implementation of clinical pathway treatment. The treatment procedures, including basic life support（BLS） recovery program and advanced life support（ALS） recovery program, as well as the treatment effect were compared in the two groups. Results Chest compressions were carried out in all the patients with septic shock, there was no significant difference; the implementation of artificial respiration to conventional methods in 27（90.0%） cases, all clinical pathway implementation, with significant difference（χ^2 = 4.143, P = 0.043）, the chest compressions and placement oropharyngeal tube of clinical path were significantly higher than the conventional recovery methods, with significant differences（χ^2 = 17.244, 54.784; P = 0.000, 0.000）. Conventional methods for associated with acute renal failure, acute cardiac insufficiency, acute pulmonary function failure and other diseases in patients with successful cases were 1, 1, 0 and 1 case, respectively, clinical pathway of successful recovery cases were 12, 5, 2 and 2 cases. On acute renal failure in two ways, there was significant differences（χ^2 = 5.121, P = 0.027）; on acute cardiac insufficiency and the acute pulmonary function failure, there were significant differences（χ^2 = 12.070, 11.224; P = 0.001, 0.001）, and other diseases on success rate of recovery were the same. Two methods in immediate recovery, recovery within 5 minutes and 5-8 minutes were compared, with significant difference（χ^2 = 24.982, 10.244, 6.772; P = 0.000, 0.002, 0.009）; the success rate of mo