急诊脓毒性休克患者1 h集束化治疗策略临床实施依从性的观察

Compliance of sepsis hour-1 bundle strategy for patients with septic shock in emergency department

目的了解淮安地区急诊脓毒性休克患者1 h集束化治疗策略实施依从性。方法对2020年1月1日至12月31日淮安急诊专科联盟中7家医院急诊中心收治的116例急诊脓毒性休克患者,行1 h集束化治疗策略实施依从性的前瞻性观察。脓毒性休克诊断符合脓毒症3.0诊断标准。结果研究期间共有283例急诊患者符合纳入标准,根据排除标准排除167例。在纳入的116例急诊脓毒性休克患者中,17.2%(20/116)患者1 h内监测乳酸、17.2%(20/116)使用抗菌药物前留取了血培养、70.1%(82/116)使用了抗菌药物、13.8%(16/116)液体复苏晶体液≥30 ml/kg以及49.1%(57/116)复苏过程中使用了血管活性药物。116例中,1 h集束化治疗策略完全执行者13例(11.2%,完全执行组),未完全执行者103例(未完全执行组)。与未完全执行组相比,完全执行组的液体复苏量明显增加[33.7(30.0,37.5)比8.9(7.3,10.8)ml/kg,Z=-4.78,P<0.001],平均动脉压明显升高[70.0(70.0,76.7)比67.7(61.7,76.7)mmHg(1 mmHg=0.133 kPa),Z=-2.00,P<0.001],血乳酸水平明显降低[3.0(2.0,3.2)比4.4(3.7,7.2)mmol/L,Z=-2.76,P=0.006]。收入重病医学科(ICU)者完全执行组9例、未完全执行组71例,两组ICU病死率[4/9比50.7%(36/71)]、住院病死率[4/13比43.7%(45/103)]和28 d病死率[4/13比44.4%(48/103)]比较,差异无统计学意义(均P>0.05)。结论急诊脓毒性休克患者1 h集束化治疗策略实施依从性差,需加强相关质量管理培训。

Objective To investigate the implementation status of sepsis hour-1 bundle strategy for patients with septic shock in emergency department.Methods A total of 116 septic shock patients admitted to the emergency department from January 2020 to December 2020 were included in this prospective study,and the implementation of sepsis bundles and the clinical outcomes of patients were recorded.Results Among 116 patients,20 cases(17.2%)had lactic acid monitored within 1 h,20 cases(17.2%)had blood culture before antibiotics,82 cases(70.1%)received broad-spectrum antibiotics,16 cases(13.8%)received fluid resuscitation≥30 ml/kg,and 57 cases(49.1%)received vasoactive drugs during resuscitation.Finally,the sepsis hour-1 bundle strategy was fully implemented only in 13 cases(11.2%).Compared with the group with incomplete implementation of sepsis hour-1 bundle strategy,the volume of fluid recovery in the group with full implementation was significantly increased[33.7(30.0,37.5)vs.8.9(7.3,10.8)ml/kg,Z=-4.78,P<0.001],mean artery blood pressure significantly increased[70.0(70.0,76.7)vs.67.7(61.7,76.7)mmHg(1 mmHg=0.133 kPa),Z=-2.00,P<0.001],and lactic acid significantly decreased[3.0(2.0,3.2)vs.4.4(3.7,7.2)mmol/L,Z=-2.76,P=0.006].However,there were no significant differences in ICU mortality,in-hospital mortality and 28-day mortality between the two groups(P>0.05).Conclusions Septic shock patients in emergency department have poor compliance with the implementation of sepsis hour-1 bundle strategy,and relevant management training should be strengthened.