1小时集束治疗对感染性休克患者的预后影响

目的研究1 h集束治疗对感染性休克患者预后的影响。 方法采取前瞻性、多中心、队列临床研究的方法，纳入2018年1月至2019年12月间连续收治的扬州市江都人民医院及苏北人民医院重症医学科感染性休克患者，根据是否完成1 h集束治疗目标，分为1 h集束治疗组及对照组。比较2组患者的预后指标及28 d病死率、集束化治疗完成时间、机械通气时间、重症医学科住院时间等。 结果共纳入感染性休克患者332例，其中1 h集束治疗完成患者91例（27.4%，91/332），1 h集束治疗未完成患者241例（72.6%，241/332）。1 h集束治疗完成患者28 d病死率（43.9%）明显低于1 h集束治疗未完成患者（58.9%），差异有统计学意义（P＜0.05）。1 h集束治疗完成患者重症医学科住院天数［（7.2±2.9） d］低于1 h集束治疗未完成患者［（7.7±3.3） d］，但差异无统计学意义。 结论1 h集束治疗能降低感染性休克患者病死率，但医务人员对1 h集束治疗的依从性低，未来需要通过努力提高医务人员对感染性休克患者1 h集束治疗的依从性。

Effect of 1-hour bundle on prognosis of patients with septic shock

ObjectiveTo evaluate the effect of 1-hour bundle on the prognosis in patients with septic shock. MethodsA prospective, multi-center, cohort clinical study was performed, in which patients with septic shock at the Department of Intensive Medicine of Jiangdu People's Hospital and Subei People's Hospital were consecutively treated from January 2018 to December 2019. According to whether to complete the 1-hour bundle, the patients were divided into either a 1-hour bundle group or a control group. The prognostic indicators were compared between the two groups. The primary endpoint was 28-day mortality. The secondary endpoints were time to completion of sepsis therapy, mechanical ventilation time, and intensive care unit (ICU) stay. ResultsA total of 332 patients with septic shock were included in the study, of whom 91 completed the 1-hour bundle, with a completion rate of only 27.4%. There were 241 patients (72.6%) who did not complete the 1-hour bundle. The 28-day mortality rate (43.9%) in the 1-hour bundle group was significantly lower than that in the control group (58.9%; P＜0.05). The number of days of ICU stay in the 1-hour bundle group (7.2±2.9) was lower than that in the control group (7.7±3.3), but there was no statistical difference. ConclusionCompletion of 1-hour bundle can reduce the mortality of patients with septic shock, but the compliance of medical staff with 1-hour bundle is low. In the future, efforts should be made to improve medical staff's compliance with 1-hour bundle of septic shock.