摘要
目的了解感染性休克集束治疗依从性，以及提高依从性对预后的影响。方法前瞻性研究21307年1月至2008年6月江苏省苏北人民医院重症医学科（ICU）连续收治的成人感染性休克患者临床资料，实验分为培训前（2007年1月至21307年9月）和培训后（2007年10月至2008年6月）两个阶段，研究两个阶段感染性休克集束治疗各项指标的依从性、机械通气时间、ICU住院时间以及28d病死率。计量资料以（x±s）表示，计数资料以率表示，采用χ2检验，成组t检验，P〈0．05为差异具有统计学意义。结果研究期间共收治符合条件感染性休克患者100例，其中培训前51例，培训后49例。培训前与培训后相比，集束治疗6h的依从性分别为早期目标导向治疗（EGDT）（19．6％vs．55．1％），红细胞压积Hcr（64．7％vs．91．8％），气道内平台压（88．2％vs．95．9％），激素使用（41．2％vs．62．3％），强心药物使用（41．2％vs．65．3％），血糖控制（45．1％vs．79．6％）。同时培训前与培训后相比，集束治疗24h的依从性分别为早期目标导向治疗（35．3％vs．65．3％），红细胞压积（35．3％vs．73．5％），气道内平台压（86．3％vs．97．9％），激素使用（31．4％vs．69．4％），强心药物使用（52．9％vs．67．3％），血糖控制（47．1％vs．83．7％）。培训后机械通气时间明显缩短（P〈0．05）、ICU住院时间明显减少（P〈0．01）及28d病死率明显降低（55．1％VS．76．5％，P〈0．05），而气道内平台压和24h强心药物使用差异无统计学意义。结论感染性休克集束治疗依从性低，继续教育培训可以提高依从性，改善感染性休克患者预后。
Objective To investigate the compliance with medical care bundles in patients with septic shock and effects of increasing compliance on prognosis. Method From January 2007 to June 2008, a prospective ob- servational study of consecutive patients with septic shock admitted into ICU was carried out. The study was divided into pre-training stage （from January 2（D7 to September 2007） and post-training stage （from October 2（}07 to June 2008）. The rate of compliance with medical care bundles for sepsis, the duration of mechanical ventilation, the duration of ICU stay and 28-day mortality in two stages were documented. The percentages for categorical variables and mean ＋ SD for continuous variables were expressed. Chi-square test and unpaired t -test were used for compar- isons of groups, and statistical significance defined as P 〈 0.05. Results One hundred patients met the criteria of septic shock including 51 patients in pre-training stage and 49 patients in pest-training stage were enrolled in the study. Compared with the post-training stage, the rates of compliance with 6- hour care bundle for sepsis in pre- training stage were expressed respectively by early goal-directed resuscitation （EGDT, 19.6% vs. 55.1% ）, HCY （hematocrit, 64.7% vs. 91.8%）, plateau pressure （88.2% vs. 95.9%）, corticostemid therapy （41.2% vs.62.3 % ）, cardiotonie medication （41.2 % vs. 65.3 % ） and blood glucose control （45.1% vs. 79.6 % ）. At the same time, the rates of compliance with the 24-hour cam bundle in pre-training stage in eomparisen with post- training stage were respectively expressed in EGDT （35.3 % vs. 65.3 % ）, HCT （35.3 % vs. 73.5 % ）, plateau pressure （86.3 % vs. 97.9 % ）, eortieosteroid therapy （31.4 % vs. 69.4% ）, administration of positive inotmpie medicine （52.9 % vs. 67.3 % ） and glucose eontrol （47.1% vs. 83.7 % ）. Patients in post-training stage had the shorter duration of mechanical ventilation （ P 〈 0.05）, shorter stay in ICU （ P 〈 0.01 ） and a lower 28-day mortality rate （55.1% vs. 76.5%, P 〈 0.05） than patients in pre-training stage. There were no significant differences in plateau pressure and eardiotonie medication between two stages. Conclusions The compliance with medical care bundles in patients with septic shock is poor. After training, physician can increase the compliance with medical care bundles for sepsis and improve prognosis.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2010年第2期150-153,共4页
Chinese Journal of Emergency Medicine
基金
江苏省“333高层次人才培养工程”基金资助（2007-58）
关键词
感染性休克
集束治疗
依从性
预后
ICU
EGDT
培训
临床研究
Septis shock
Sepsis bundles
Compliance
prognosis
Intensive care unit
Early goal-directed resuseitation
Training
Clinical study
