中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (12): 1006-1008.

• 论著 • 上一篇    下一篇

集束化治疗依从性及对严重脓毒症和脓毒性休克病人病死率影响的研究

吴健锋，陈 娟，欧阳彬，杨春华，陈敏英，黄顺伟，管向东   

  1. 中山大学附属第一医院SICU, 广东广州510080
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-12-18 发布日期:2009-12-18

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-12-18 Published:2009-12-18

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摘要：

目的 评估集束化治疗在ICU实施的依从性及对严重脓毒症和脓毒性休克病人病死率的影响。方法 2007年1月至2008年12中山大学附属第一医院连续收治的122例严重脓毒症和脓毒性休克病人进行6h、24h集束化治疗，采用前瞻观察的方法，了解集束化治疗的依从性及对病人ICU和28d病死率的影响。结果 集束化治疗中EGDT和血糖控制由于其操作的复杂性及自身的缺陷，依从性偏低，其他各项依从性都在90%以上。6h、24h集束化治疗达标的依从性分别为61.5%和60.7%。6h达标的病人ICU、28d病死率分别是18.7%和22.7%，未达标病人的ICU、28d病死率分别是38.3% 和44.7%；24h达标的病人ICU、28d病死率分别是15.5%和19.7%，未达标病人的ICU、28d病死率分别是34.8% 和41.3%，达标的病人ICU病死率和28d病死率都明显比未达标病人的低（P＜0.05）。结论 集束化治疗可以降低严重脓毒症和脓毒性休克病人的病死率，但可能还需进一步优化以提高临床的可行性。

关键词: 集束化治疗, 依从性, 严重脓毒症, 脓毒性休克

Abstract:

The compliance of implementing sepsis bundles and their effects on mortality of patients with severe sepsis or septic shock WU Jian-feng, CHEN Juan, OU Yang-bin, et al. Department of Surgical Intensive Care Unit, the First Affiliated Hospital of SUN Yat-sen University, Guangzhou 510080, China Corresponding author: GUAN Xiang-dong, E-mail: carlg@163.net Abstract Objective To evaluate the compliance of implementing sepsis bundles in the ICU and their effect on outcomes of patients with severe sepsis or septic shock. Methods In the prospective observational study, it took to applying sepsis bundle interventions for 6h, 24h in 122 consecutive patients with severe sepsis or septic shock admitted from January 2007 to December 2008 at the First Affiliated Hospital of Sun Yat-sen University. The compliance of performing sepsis bundles, ICU and 28-day mortality were recorded. Results The compliance rate of controlling glucose and EGDT was low (both＜70%) because both had defects and difficulty in implementation. Compliance with the 6-hour bundle was obtained in 75 (61.5%) of 122 patients; those patients had a lower 28-day mortality rate (22.7% vs 44.7%, P＜0.05) and lower ICU mortality rate (18.7% vs 38.3%, P＜0.05) than other patients. Compliance with the 24-hour bundle was obtained in 71 (60.7%) of 117 eligible patients. Patients complied with the 24-hour sepsis bundle had a lower 28-day and ICU mortality rate than those who were noncompliant (19.7% vs 41.3%, 15.5% vs34.8%, both P＜0.05). Conclusion Correct application of the sepsis bundles was associated with reduced mortality and length of ICU stay.

Key words: sepsis bundle, compliance, severe sepsis, septic shock