严重感染和感染性休克早期集束化治疗临床分析

Clinical analysis of early bundled care for severe sepsis and septic shock

目的观察严重感染和感染性休克患者采取早期集束化治疗的临床效果。方法将2006年1月～2008年12月该科收治的41例严重感染和感染性休克作为"早期集束化治疗"治疗组,按照《2004年国际严重感染和感染性休克治疗指南》采取6～24 h内早期集束化治疗,包括早期目标指导治疗(EGDT)、1 h内经验性广谱抗生素、糖皮质激素的应用、严格控制血糖治疗、机械通气控制平台压、镇静镇痛治疗等。选择2004年1月～2005年12月41例严重感染和感染性休克患者按照"传统经验性治疗"方法进行治疗的患者作为对照组。结果 41例早期集束化治疗组:6 h EGDT达标35例,达标率为85.36%;住院28 d死亡11例,病死率为26.83%。41例对照组:6 h EGDT达标18例,达标率为43.90%;住院28 d死亡21人,病死率为51.22%。治疗组与对照组比较,6 h EGDT达标率及病死率的差异具有显著性(均P<0.05)。结论对严重感染和感染性休克患者采取早期集束化治疗策略较传统的经验性治疗可以明显提高患者生存率,减少病死率。

【Objective】 To observe the clinical efficacy of early bundled care in severe sepsis and septic shock.【Methods】 A total of 41 patients admitted to the intensive care unit（ICU） from January 2006 to December 2008 with severe sepsis and septic shock were assigned into ＂early bundled care＂ treatment group,given 6～24 hours early bundled care including early-goal-directed therapy,intravenous antibiotics within the first hour of recognized severe sepsis and septic shock,steroids,strict glucose control,control plateau pressure,sedation and analgesia according to Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock.Another group of 41 patients admitted to the intensive care unit from January 2004 to December 2005 with severe sepsis and septic shock received traditional empirical treatment were assigned into the control group.【Results】 Among the 41 cases of early bundled treatment group 35 cases reached early goal with compliance rate of 85.36%,11 cases died in 28 days with the mortality of 26.83%.Among the 41 patients in control group 18 cases reached early goal with the compliance rate of 43.90%,21 cases died in 28 days with the mortality of 51.22%.There were significant differences in patients＇ compliance rate and mortality between treatment group and control group（P 〈0.05）.【Conclusion】 Early bundled care for severe sepsis and septic shock can significantly improve survival rates and reduce mortality.