早期复苏对严重脓毒血症和脓毒性休克的脏器功能影响

The effect of sufficient resuscitation on organ functions in patients with severe sepsis and septic shock

目的:探讨严重脓毒血症和脓毒性休克病人早期充分复苏对脏器功能和后续治疗反应的影响。方法:2004年6月至2005年8月,我院外科监护病房和呼吸监护病房连续收治的严重脓毒血症和脓毒性休克病人共28例,进行及时充分复苏治疗。根据复苏达标时间是否超过12 h将病人分为早期复苏组(12例)和晚期复苏组(16例),较两组病人对后续治疗的反应和脏器功能影响。结果:晚期复苏组需再次复苏治疗者占68.8%,早期复苏组为16.7%(P<0.01)。复苏后第7天,早期复苏组血AST、ALT、Cr均显著低于晚期复苏组(P<0.05);复苏后,早期复苏组各时点心率(HR)均显著低于晚期复苏组(P<0.05);复苏7 d后,早期复苏组PaO2和PaO2/FiO2均显著高于晚期复苏组(P<0.05)。比较院内死亡率,晚期复苏组为43.8%,早期复苏组8.3%(P<0.05)。结论:早期充分复苏治疗可明显增强严重脓毒血症和脓毒性休克病人对后续治疗的敏感性,并减轻对重要脏器功能的损害,从而降低其死亡率。

Objective To evaluate the effect of early and sufficient resuscitation on important organ functions in patients with severe sepsis and septic shock. Methods From Jun 2004 to Aug 2005, 28 patients with severe sepsis and septic shock were admitted to respiratory intensive care unit and surgical intensive care unit. According to the time and duration of resuscitation, these patients were divided into early resuscitation group （E group, 12 patients） and later resuscitation group （L group, 16 patients） in terms of vital organ functions recovery and final outcome. Results The incidence of repeated resuscitation was 69% in the L group and 17% in the E group（P〈0.01）. Seven days after resuscitation, the serum concentrations of AST, ALT and Cr in the E group were lower than those in the L group（P〈0.05）. Three or seven days after resuscitation, heart rate in the E group was lower than those in the L group（P〈0.05）. Seven days after resuscitation, PaO2, PaO2/FiO2were higher in the E group than in the L group（P〈0.05）. The mortality was 44% in the L group and 8% in the E group （P〈0.05）. Conclusions Early and sufficient resuscitation of severe sepsis and septic shock patients could significantly enhance the effect of their vital organ functions recovery and final outcome.