感染性休克抗感染治疗的回顾性分析

Retrospective analysis of treatment for septic shock

目的回顾性分析急诊科感染性休克患者采用6 h集束化抗感染治疗的实施及临床疗效。方法回顾性分析本院急诊科2013年1月至2014年12月集束化抗感染治疗的感染性休克患者173例的临床资料,观察分析患者的一般资料,病死率及其相关因素、集束化治疗方法,完全集束化治疗实施率及完全集束化治疗对病死率的影响。结果年龄高于60岁、APACHEⅡ评分高于20分、全身炎症反应综合征(SIRS)及多脏器功能失常综合征(MODS)发生为感染性休克患者病死的独立高危因素。血乳酸检测实施率(93.6%)、3 h内广谱抗菌药物应用实施率(95.4%)、液体复苏效果不佳给予升压治疗实施率(91.3%)较高,但完全集束化抗感染治疗仍有较大的上升空间,其中抗菌药物治疗前病原菌培养实施率较低(69.9%),完全集束化治疗者病死率(36.7%)低于非完全集束化治疗病死率(56.7%)(χ2=6.564、P=0.0104)。结论感染性休克患者急诊6 h内完全集束化抗感染治疗能够有效的达成目标化治疗指标控制,提升急诊医师对完全集束化治疗的实施率能够进一步降低感染性休克患者的病死率。

Objective To analyze the method and clinical effect of 6 h bundle of anti-infective therapy in patients with septic shock in emergency department, retrospectively. Methods Total of 173 cases of infection shock with cluster of anti-infective therapy from January 2013 to December 2014 in emergency department of our hospital were analyzed, retrospectively and were set as the research objects, the effects of general data of patients, mortality rate and the related factors, cluster treatment method, cluster treatment implementation rate and complete bundle treatment on mortality were analyzed, respectively. Results Age above 60 years old, APACHE II score higher than 20, systemic inflammatory response syndrome（SIRS） and multiple organ dysfunction syndrome（MODS） occurred in patients with septic shock and mortality were all independent risk factors. The implementation rates were higher of blood lactate detection, broad-spectrum antibacterial drug application in 3 h, fluid resuscitation effect was poor and given boost therapy. But there was still a significant rise in non-complete bundle therapy. the implementation rate of pathogenic bacteria was low before the treatment, and the fatality rate of cases with complete bundle therapy was lower than that of complete bundle therapy（χ^2 = 6.564, P = 0.0104）. Conclusions Septic shock patients were treated by antiinfection treatment within 6 h in emergency, which could effectively achieve the goal of treatment index control, and improve the implementation rate of complete bundle of emergency physician, then furtherly reduce the mortality rate of patients with septic shock.