不同时机进行早期目标导向治疗对脓毒性休克预后的影响

Effect of early goal directed therapy in different phases on prognosis of patients with septic shock

目的研究不同时机采取早期目标导向治疗(EGDT)对脓毒性休克患者临床预后的影响。方法 2010年1月至2014年1月新乡市第二人民医院重症监护病房收治的脓毒性休克患者49例,其中23例患者(观察组)的血乳酸≥4 mmol·L-1,收缩压>90 mmHg(1 mmHg=0.133 kPa),经治疗6 h后血乳酸<2 mmol·L-1维持3 d,另26例患者(对照组)符合收缩压<90 mmHg或比基础值下降>40 mmHg、尿量<0.5 mL·kg-1·h-1、皮肤湿冷等传统的脓毒性休克临床表现。2组患者在常规治疗基础上,均行EGDT,比较2组患者治疗前与治疗1、2、3 d的序贯器官衰竭评分(SOFA)。结果在治疗前及治疗1 d,观察组与对照组的SOFA评分差异无统计学意义(P>0.05)。治疗2、3 d,观察组的SOFA评分与对照组相比明显下降,差异有统计学意义(P<0.05)。结论选择脓毒性休克治疗的最佳时机,可促使尽早干预,改善预后,血乳酸水平为临床上诊断、治疗脓毒性休克提供了客观依据。

Objective To research the effect of early goal-directed therapy（EGDT） in the different phases on clinical prognosis of patients with septic shock. Methods From January 2010 to January 2014,forty-nine patients with septic shock in Intensive Care Unit of the Second People＇s Hospital of Xinxiang City were divided into observation group（ n = 23 ） and control group（ n = 26 ）. In the observation group, 23 patients with lactic acid concentration≥4 mmol· L^-1 and systolic presure 〉 90 mmHg（ 1 mmHg = 0. 133 kPa）were treated with EGDT for 6 h to decrease the lactic acid concentration less than 2 mmol· L^-1 for 3 days. Twenty-six patients in the control group（ systolic presure 〈 90 mmHg or lower than basic value 〉 40 mmHg, urine amount 〈0.5 mL· kg^-1 · h^-l, clammy skin and other traditional clinical manifestation） were also treated with EGDT. The sequential organ failure score（SOFA） of the two groups before treatment and after treated with EGDT for 1 day and 2,3 days were analyzed. Results The SOFA score of patients in the two groups had no statistical significance before treatment and after treated with EGDT for 1 day（P 〉0.05）. After treated with EGDT for 2 and 3 days,the SOFA score of patients in the observation group were significantly lower than those in control group （ P 〈 0.05 ）. Conclusion Lactic acid can be found earlier montoriseptic shock, which can prompt intervention as soon as possible and improve prognosis. It provides an objective basis to grasp the best time for clinical treatment of the septic shock patient.