早期目标指导治疗对多器官功能障碍综合征发病率、严重度及死亡率的影响

Early goal-directed therapy lowers the incidence, severity and mortality of multiple organ dysfunction syndrome

目的研究早期目标指导治疗(EGDT)对多器官功能障碍综合征(MODS)发病率、严重度及死亡率的影响。方法采取前瞻性、随机、对照研究方法,将休克早期、有发展为MODS倾向的患者随机分为EGDT组(给予EGDT)和对照组(给予传统经验治疗)。记录两组患者入ICU时急性生理和慢性健康评分(APACHEII)、血乳酸浓度、序贯性器官衰竭评分(SOFA),第2、4天血乳酸浓度,住院期间最高SOFA评分,同时计算SOFA评分差值,器官衰竭数目,并统计ICU死亡率。结果EGDT组MODS发病率明显低于对照组(P=0.002)。EGDT组MODS患者的第2、4天血乳酸浓度、住院期间最高SOFA评分,SOFA评分差值、器官衰竭数目明显低于对照组(P=0.045,0.016,0.009,0.010,0.002)。EGDT组MODS患者死亡率明显低于对照组(P=0.007)。EGDT组中严重感染与非严重感染伴发MODS患者死亡率均明显低于对照组(P=0.047,0.044)。结论EGDT可以减少MODS发病率,减轻MODS严重度,以及不仅可以降低严重感染伴发MODS患者死亡率,同时也可以降低非严重感染伴发MODS患者死亡率。

Objective To investigate the effect of early goal-directed therapy （EGDT） on the incidence, severity and mortality of multiple organ dysfunction syndrome （MODS）. Methods A prospective, randomized controlled trial was performed involving 273 patients in the early stage of shock at risk of potential MODS development. The patients were randomly divided into EGDT group （including 139 patients managed with EGDT） and control group （including 134 patients with conventional empirical therapy）. The scores of APACHE Ⅱ, blood lactate concentration （Lactate0） and SOFA scores （SOFA0） of the two groups were recorded on admission, and the lactate concentration on the second and fourth day of hospitalization （Lactate2 and Lactate4）, and the highest SOFA scores （SOFAT） after admission were also recorded. The discrepancy between the two SOFA scores （SOFAΔ）, number of the dysfunctional organ, and the mortality in ICU of the two groups were calculated at the end of the study. Results The incidence of MODS in the EGDT group was significantly lower than that in control group （P=0.002）. The Lactate2, Lactate4, SOFAT, SOFAzx, and the number of dysfunctional organs in EGDT group were also significantly lower （P=0.045, 0.016, 0.009, 0,010, 0.002）. EGDT was associated with a significantly lower total mortality rate of MODS than the conventional therapy （P=0.007）, and also with a significantly lower mortality rate of MODS after controlling for severe sepsis （P=0.047 and 0.044）. Conclusions EGDT can decrease the incidence and severity of MODS, and can effectively decrease the mortality of MODS irrespective of the presence of severe sepsis.