脓毒症3.0指南对基层医院脓毒症患者预后的影响

The influence of Sepsis 3.0 Guideline on the prognosis of sepsis patients

目的分析脓毒症3.0指南对基层医院脓毒症患者预后的影响。方法回顾性分析2013年1月1日—2016年2月29日入住独山子人民医院重症医学科(ICU)的脓毒症患者将其设为对照组。从2016年3月1日—2018年12月31日开始对收治ICU的脓毒症患者严格按照脓毒症Sepsis 3.0的指南要求,结合实际条件进行规范化诊断与治疗,而进行前瞻性研究并将其设为规范化诊疗组。规范化诊疗组在经过脓毒症管理之后与对照组比较两组28 d病死率、ICU住院费用及ICU住院时间等情况。结果最终纳入脓毒症患者96例,其中规范化诊疗组为49例,对照组47例。规范化诊疗组在PCT达标率,乳酸检测率,抗生素1 h、3 h完成率,2 h内深静脉置管完成率方面均优于对照组(P<0.05);在日均ICU住院费用上,规范化诊疗组为4982.61(3700.06,6301.18)元,对照组为6077.92(4703.90,7521.01)元,两组比较差异有统计学意义(P<0.05);规范化诊疗组28 d病死率为14.29%,对照组为27.66%,两组比较差异有统计学意义(P<0.05)。结论根据脓毒症3.0指南在基层医院进行脓毒症规范化诊疗管理,可以明显降低脓毒症患者的病死率、ICU日均住院费用,建议将脓毒症管理纳入医院级管理。

Objective To analyze the effect of Sepsis 3.0 Guideline on the prognosis of sepsis patients.Methods Sepsis patients admitted to the intensive care unit(ICU)of Dushanzi People′s Hospital from January 1,2013 to February 29,2016 were retrospectively analyzed and set as the control group.From March 1,2016 to December 31,2018,the patients with sepsis in ICU were diagnosed and treated in strict accordance with the guidelines of Sepsis 3.0 Guideline and in combination with the actual conditions.They were prospectively studied and set as the standardized diagnosis and treatment group.After sepsis management,the 28 day mortality,ICU hospitalization expenses and ICU hospitalization time of the two groups were compared.Results 96 patients with sepsis were included,including 49 cases in the standardized diagnosis and treatment group and 47 cases in the control group.The standardized diagnosis and treatment group was better than the control group in PCT compliance rate,lactate detection rate,completion rate of antibiotics at 1 h and 3 h,and completion rate of deep venous catheterization within 2 h(P<0.05).In terms of daily average ICU hospitalization expenses,the standardized diagnosis and treatment group was 4982.61(3700.06,6301.18)yuan and the control group was 6077.92(4703.90,7521.01).There was significant difference between the two groups(P<0.05).The 28 day mortality in the standardized diagnosis and treatment group was 14.29%and that in the control group was 27.66%.There was significant difference between the two groups(P<0.05).Conclusion The standardized diagnosis and treatment management of sepsis in primary hospitals according to Sepsis 3.0 Guideline can significantly reduce the mortality of patients with sepsis and the average daily hospitalization cost of ICU.It is suggested to bring sepsis management into hospital level management.