脓毒性休克患者的液体平衡与器官损伤及预后的关系

目的 探讨脓毒性休克患者治疗前7 d的液体平衡状态与器官损伤及预后的关系.方法 采用回顾性对照方法,研究2004-01～2008~(-1)2收入大连市中心医院急诊重症监护病房(EICU)的脓毒性休克患者86例,按7 d内液体平衡程度将患者分为负平衡组和正平衡组,将基础疾病、年龄≥60岁、治疗前APACHEⅡ评分≥20分、治疗前血清白蛋白≤30 g/L、治疗前血肌酐≥200 μmol/L及抗生素治疗有效率等作为影响因素进行Logistic回归分析,同时比较两组液体平衡值、中心静脉压(CVP)、全身性感染相关性器官功能衰竭评分(SOFA)、C反应蛋白(CRP)、血乳酸(LAC)及预后.结果 负平衡组液体负平衡多在第3～5天出现,同时伴随SOFA评分和CRP、LAC水平下降,与正平衡组比较差异均有统计学意义(F分别为27.87、842.68、115.54,P均<0.05).7 d内负平衡组死亡率从D1至D5与正平衡组比较差异均有统计学意义(χ~2分别为5.23、14.61、11.17、37.59、5.24,P均＜0.05).对影响液体平衡的危险因素进行Logistic回归分析表明,糖尿病、心功能不全、年龄≥60岁、治疗前血肌酐≥200 μmol/L、抗生素治疗有效率是液体正、负平衡的独立影响因素(P分别为0.016、0.023、0.003、0.018、0.001).结论 脓毒性休克患者7 d内出现液体负平衡提示感染得到有效控制,可作为预后评价的指标之一.糖尿病、心功能不全、年龄≥60岁、治疗前血肌酐≥200 μmol/L、抗生素治疗有效率是液体正、负平衡的独立影响因素.

Relationship between fluid balance and organ damage,the prognosis in the patients with septic shock

Objective To investigate the relationship between the negative fluid balance of the first seven days and organ damage,the outcomes in the patients with septic shock. Methods This was a retrospective controlled study. Medical records of 86 patients admitted to our emergency ICU from January 2004 to December 2008 were examined.86 patients were divided into two groups according to negative or positive fluid balance of the first 7 days. A number of demographic and physiology variables were collected from the medical records, including age, basic diseases, albumin, serum creatinine, APACHEⅡscores, etc. Sequential organ failure assessment(SOFA)scores, C-reaction protein(CRP), lactate(LAC), effective rate of antibiotics treatment and the outcomes were compared in two groups. Results There was significant difference in survival rate between patients with negative fluid balance and the patients with positive fluid balance.Patients with negative fluid balance had low SOFA scores, CRP and LAC level, APACHEⅡscores and high effective rate of treatment with antibiotics. There were significant differences in two groups. Conclusion Negative fluid balance within the first 7 days of treatment in the patients with septic shock indicates that the infection is effectively controlled and may be a good predictor for the prognosis.Diabetes,cardiac dysfunction,age≥60 years old,serum creatinine≥200 μmol/L before the treatment,effective rate of antibiotics treatment are independent risks of fluid balance.