集束化管理对胸外科患者术后合并重症感染预后的影响

Effect of cluster management on prognosis of chest trauma patients complicated with postoperative severe infections

目的探讨集束化治疗策略对胸外科患者术后合并重症感染预后和降低病死率的作用,为临床资料提供参考依据。方法选取2009年1月-2013年2月ICU收治的79例胸外科术后合并重症感染患者临床资料,随机分为观察组40例和对照组39例,其中对照组采用常规的治疗策略,观察组在常规治疗的基础上实施严格6h集束化治疗方案,观察对比两组患者序贯器官衰竭估计(SOFA)评分、早期目标化治疗(EGDT)目标达标率、平均住院时间、血管活性药物使用时间、28d病死率及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)及28d内机械通气时间情况,采用SPSS16.0软件对所收集的数据进行统计处理分析,计量资料数据用t检验;计数资料采用χ2检验。结果观察组患者的SOFA评分为(7.9±2.2)、(7.4±2.3)、(6.2±2.5)、(8.4±5.3)分,呈下降趋势,观察组在第3天和第1天明显低于同期的对照组(P<0.05);观察组患者在血管活性药物使用时间为(2.2±1.6)d、早期目标化治疗(EGDT)达标34例,达标率为87.2%、平均住院时间为(9.8±5.1)d,28d病死8例,病死率为20.5%,与对照组相比差异有统计学意义(P<0.01);两组在28d内机械通气时间、APACHEⅡ评分差异无统计学意义。结论集束化治疗可以明显改善重症感染患者的预后,显著降低病死率,在临床上值得推广。

OBJECTIVE To discuss the effect of cluster treatment strategy on the prognosis of the chest trauma patients complicated with postoperative severe infections and the decrease of mortality rate so as to provide basis for clinical data. METHODS The clinical data from 79 cases of chest trauma patients complicated with postoperative severe infections were selected and randomly parted into the observation group with 40 cases and the control group with 39 cases. The control group used conventio.nal treatment strategies and the observation group used strict implementation of the 6h cluster treatment programs based on the conventional treatment. The two groups were compared with sequential organ failure assessment （SOFA） score, early goal-directed therapy （EGDT） target standard rate, average hospitalization time, vasoactive drug use time, 28-day mortality rate, and acute physiology and chronic health evaluation （APACHE Ⅱ） and the duration of mechanical ventilation in 28 days. SPSS16.0 software was used for the data analysis, t-test for measurement data, chi square test for the count data. RESULTS The SOFA scores in the observation group were （7.9±2.2）, （7.4±2.3）, （6.2±2.5）, and （8.4±5.3）, which showed a downward trend, and the scores in the third day and the first day were significantly lower than those of the control group at the same period of time （P〈0.05）, the vasoactive drug use time of patients in observation group was （2.2±1.6） days , the standard cases of early goal treatment （EGDT） was 34 cases （87.2%）; the average hospitalization duration was （9.8 ± 5.1）days, the 28-day mortality was 20.5% （8 cases）, as compared with the control group, the difference was statistically significant （P〈0. 01） ; the difference in the 28-day mechanical ventilation duration or APACHE H score was not significant. CONCLUSION The cluster treatment can significantly improve the prognosis of chest trauma patients complicated with postoperative severe infections and obviously reduce the mortality, it is worthy to be promoted in the hospital.