临床决策系统助力提高脓毒症休克集束化治疗依从性

Clinical decision support system helps to improve the compliance of bundle therapy for septic shock

目的提高医护人员对脓毒症休克集束化治疗的依从性和执行率。方法选择脓毒症休克患者144例随机分为对照组和试验组。对照组按指南要求在脓毒症休克诊断1 h、3 h、6 h内分别完成既定的集束化治疗措施;试验组利用重症智能临床决策系统脓毒症休克质量控制模块,建立脓毒症休克诊断后1 h、3 h、6 h内的集束化治疗路径流程,系统在每个特定的时间段及时、反复对医护人员进行提醒,直到脓毒症休克集束化治疗措施各指标完成。比较两组集束化治疗效果,包括1 h、3 h、6 h目标完成率、平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)、中心静脉血氧饱和度(central venous oxygen saturation,ScvO2)、6 h乳酸清除率(lactate clearance,LCR)、尿量、去甲肾上腺素剂量、结局指标。结果试验组集束化治疗1 h、3 h、6 h目标完成率均高于对照组(P<0.05),两组MAP、CVP、尿量比较差异无统计学意义(P>0.05),试验组ScvO2、6 h LCR低于对照组,去甲肾上腺素高于对照组(P<0.05),试验组ICU住院时间短于对照组(P<0.05),两组28 d病死率比较差异无统计学意义(P>0.05)。结论重症智能临床决策系统通过对数据汇总分析可及时预警、诊断脓毒症休克,通过特定时间段内及时、反复提醒,可以促进脓毒症休克集束化治疗各项目的有效实施,改善脓毒症休克患者的治疗效果,提高脓毒症休克治疗效率和医疗护理质量。

Objective To improve the compliance and implementation rate of bundle therapy for septic shock.Methods A total of 144 patients with septic shock were randomly divided into control group and experimental group.The control group completed the established bundle treatment measures within 1 h,3 h and 6 h after the diagnosis of septic shock according to the guidelines.The experimental group used the septic shock quality control module of intelligent clinical decision support system for severe diseases to establish the bundle treatment path process within 1 h,3 h and 6 h after the diagnosis of septic shock.The system timely and repeatedly reminded the medical staff in each specific time period until the indicators of septic shock bundle treatment measures were completed.The effects of bundle therapy were compared between two groups,including 1 h,3 h and 6 h target completion rate,mean arterial pressure(MAP),central venous pressure(CVP),central venous oxygen saturation(ScvO2),6-hour lactate clearance rate(LCR),urine volume,norepinephrine dose and outcome indicators.Results The target completion rates of 1 h,3 h and 6 h in the experimental group were higher than those in the control group(P<0.05).There was no significant difference in MAP,CVP and urine volume between two groups(P>0.05).ScvO2 and 6 h LCR in the experimental group were lower than those in the control group,while norepinephrine dose was higher than that in the control group(P<0.05),and the length of ICU stay in the experimental group was shorter than that in the control group(P<0.05).There was no significant difference in 28-day mortality between two groups(P>0.05).Conclusion Intelligent clinical decision support system for severe diseases can timely warn and diagnose septic shock through data collection and analysis.Timely and repeated reminders within a specific period of time can promote the effective implementation of various projects of septic shock bundle therapy,significantly improve the therapeutic effect in the treatment of patients with septic shock,and improve the treatment efficiency of septic shock and the quality of medical care.