中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (12): 1000-1002.

• 论著 • 上一篇    下一篇

外科严重脓毒症早期目标指导治疗应用价值研究

戴海文，张召才，严 静，蔡国龙，龚仕金，虞意华，陈 进，谭成戊，颜墨磊，吴 亮   

  1. 浙江医院ICU，浙江杭州310013
  • 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

PDF

摘要：

目的 探讨早期目标指导治疗（EGDT）治疗外科严重脓毒症临床价值。方法 将2004年8月至2007年6月收治于浙江省7家三甲医院ICU的 177例外科严重脓毒症病人随机分为常规组（n=90）和EGDT组（n=87）。前者以中心静脉压（CVP）、平均动脉压（MAP）或收缩压（SBP）、尿量（UO）变化指导液体复苏，后者在此基础上增加中心静脉血氧饱和度（ScvO2）为观测指标进行复苏；入选后，对病人行输液、输血和强心等治疗，6h内达标；比较两组病人28d存活率（主要终点）、ICU住院时间、机械通气时间、抗生素使用时间、合并新感染情况和临床评分（次要终点）的差异。结果 EGDT组28d存活率较常规组增高约18％（79.3% vs 61.1%, P=0.023），EGDT明显改善APACHE II评分（21.7±5.9 vs 15.4±4.3，P=0.008 ）和MODS评分（8.4±3.3 vs 5.1±2.9, P=0.017），EGDT对其他次级终点均无显著影响（均P>0.05）。结论 EGDT可以显著改善外科脓毒症病人28d存活率和临床评分，对病人预后有益。

关键词: 脓毒症, 液体复苏

Abstract:

Value of early goal-directed therapy for treatment of surgical patients with severe sepsis DAI Hai-wen, ZHANG Zhao-cai, YAN Jing, et al. Department of Intensive Care Unit, Zhejiang Hospital, Hangzhou 310013, China Corresponding author: YAN Jing, E-mail: zjicu@vip.163.com Abstract Objective To investigate the effect of early goal-directed therapy (EGDT) on surgical patient with severe sepsis. Methods One hundred and seventy-seven surgical patients with severe sepsis admitted between August 2004 and June 2007 at 7 hospitals of Grade III Level A in Zhejiang Province were randomized to conventional treatment group (n=90) and EGDT group (n=87), the former was underwent fluid resuscitation goaled by central venous pressure (CVP), mean artery blood pressure (MBP) or systolic blood pressure (SBP) and urinary output, and the latter was guiding by CVP, MBP or SBP and UO plus central venous oxygen saturation (ScvO2)；The patients were achieved the goals by treating with fluid, transfusions and cardiac stimulants in a period of 6 hours after enrollment. The difference of 28-day survival (primary endpoint), the length of stay in ICU, mechanical ventilation time, antibiotics utilization time, complication of newly infection and clinical scores (secondary endpoints) between the 2 groups was compared. Results In comparison with conventional group, the 28-day survival of EGDT group was increased by 18% (79.3% vs 61.1%, P=0.023), the APACHE II score and MODS score were significantly improved after 6h of EGDT fluid resuscitation (APACHE II: 21.7±5.9 vs 15.4±4.3, P=0.008; MODS: 8.4±3.3 vs 5.1±2.9, P=0.017), there is no difference in other parameters for secondary endpoint (all P>0.05). Conclusion EGDT improved 28-day survival and clinical scores and had beneficial effects on outcomes in surgical patients with severe sepsis.

Key words: sepsis, fluid resuscitation