目标指导下治疗脓毒性休克的疗效观察

Efficacy of goal-directed therapy in the treatment of septic shock

目的对比观察目标指导下脓毒性休克的治疗和传统经验治疗对息者预后的影响。方法采用随机、对照的方法对脓毒性休克患者进行目标指导下的治疗，目标：①中心静脉压（CVP）8～12mmHg（1mmHg=0．133kPa）；②平均动脉压（MAP）≥65mmHg；③上腔静脉血氧饱和度（SvO2）〉0．70；④尿量≥0．5ml／min。同时与经验性指导治疗的患者进行对比。观察两组患者人院后6、24和48hMAP、CVP、动脉血气分析、上腔静脉血气分析、静脉血乳酸含量、心脏每搏量、心排血指数、液体总量、血管活性药物总量、受损器官数目、呼吸机使用例数及7d和14d病死率。结果目标指导治疗组在较短时间内即可纠正休克和组织缺氧状态，24h和48h动脉血氧饱和度（SaO2）、SvO2、MAP、CVP较经验治疗组明显增高（P〈0．05或P〈0．01），乳酸含量降低（P〈0．01），经静脉输入的液体总量较多（P〈0．01），而血管活性药物应用较少（P〈0．01）；48hSaO2、SvO2、MAP、CVP的改善更加显著，受损器官数目少，程度较经验治疗组轻；7d及14d的病死率目标指导治疗组也较经验治疗组低（P〈0．05）。结论目标指导治疗脓毒性休克与经验治疗组相比可明显改善休克的预后。

Objective To investigate the efficacy and effect on outcome of goal-directed therapy in patients with septic shock compared with conventional therapy. Methods Sixteen patients with septic shock were randomly assigned to receive goal-directed therapy, with central venous pressure （CVP） 8 - 12 mm Hg （1 mm Hg=0. 133 kPa）, mean arterial pressure （MAP） ≥65 mm Hg, venous oxygen saturation （SvO2）〉0.70 （superior vena cava saturation）, and urine output ~ 0.5 ml/min as therapeutic goals. Another 17 patients received conventional therapy as controls. The arterial oxygen saturation （SaO2）, SvO2, MAP, CVP, heart stroke volume cardiac index （CI）, serum lactate, volume of fluid, amount of vasopressors, the numbers of organ injuried and patients who needed continuity blood purification （CBP） and/or ventilation were recorded serially for 6 - 48 hours, and they were compared between the two groups. The mortality of the patients in two groups on 7 days and 14 days were also recorded. Results There were no significant differences between the groups with respect to base-line characteristics. During the interval from 24 to 48 hours, the patients assigned to goal-directed therapy had a significantly higher in SaO2, SvO2, MAP, CVP, CI （P〈0. 05 or P〈0.01）, a lower lactate concentration （P〈0.01）, significantly more fluid during 6- 24 hours and less vasopressors （both P〈0.01）. Seven and 14 days in-hospital mortality were lower in goal-directed therapy group as compared with the control group （P〈0.05）. Conclusion The efficacy of goal-directed therapy in patients with septic shock is significantly better than conventional therapy in ameliorating outcome of shock and can be easily used in intensive care unit （ICU）.