早期集束化治疗对泌尿外科微创术后感染性休克的效果观察

Effect of early cluster therapy on septic shock after minimally invasive urological surgery

目的探讨早期集束化治疗对泌尿外科微创术后感染性休克的临床效果。方法抽取2017年7月至2022年4月河南中医药大学第一附属医院泌尿外科收治的经微创手术治疗后出现感染性休克的40例患者为研究对象,按照住院时间将其分为对照组(2017年7月至2019年8月住院)和观察组(2019年9月至2022年4月住院),每组20例。对照组给予常规治疗方案,观察组在早期给予集束化治疗方案,发病6 h内完成相关治疗处置。对不同时间点两组患者生命体征、炎性指标和休克病情相关量表进行评价。结果治疗6 h,两组患者生命体征如心率、平均动脉压(MAP)、中心静脉压(CVP)以及血氧饱和度(SaO_(2))均有明显改善,并且观察组MAP、CVP、SaO_(2)高于对照组,差异有统计学意义(t=3.74、8.79、5.83,P均<0.05)。治疗24 h,两组炎性指标中性粒细胞和降钙素原均有明显改善,并且观察组降钙素原低于对照组,差异有统计学意义(Z=2.24,P<0.05)。治疗6、24 h,两组ApacheⅡ和序贯器官衰竭评估评分呈下降趋势,并且观察组上述评分均低于对照组,差异有统计学意义(F=550.85、417.58,P均<0.05)。结论早期集束化治疗方案对于泌尿外科术后感染性休克效果显著,能够尽快稳定患者的生命体征,减轻感染症状,有效避免脏器功能进一步损伤。

Objective To investigate the clinical effect of early cluster therapy on septic shock after minimally invasive urological surgery.Methods A total of 40 patients with septic shock after minimally invasive surgery in the Department of Urology of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from July 2017 to April 2022 were selected as the research objects.The patients were divided into control group(hospitalized from July 2017 to August 2019)and observation group(hospitalized from September 2019 to April 2022)according to the length of hospital stay,with 20 cases in each group.The control group treated by the conventional plan,the observation group treated by the bundled strategy in the early stage,and the related treatment was completed within 6 hours of the onset.The vital signs,inflammatory indexes and shock disease-related scales of patients in the two groups at different time points were evaluated.Results After 6 hours of treatment,the vital signs including heart rate,mean arterial pressure(MAP),central venous pressure(CVP)and blood oxygen saturation(SaO_(2))were significantly improved in both groups,and the MAP,CVP and SaO_(2) of the observation group were higher than those of the control group,and the differences were significant(t=3.74,8.79,5.83;all P<0.05).After 24 hours of treatment,the inflammatory indexes including neutrophils and procalcitonin of the two groups were significantly improved,and the procalcitonin of the observation group was lower than that of the control group,and the difference was significant(Z=2.24,P<0.05).After 6 and 24 hours of treatment,the Apache II and sequential organ failure assessment scores in the two groups showed a downward trend,and the above scores of the observation group were lower than those of the control group,and the differences were significant(F=550.85,417.58;all P<0.05).Conclusions The early bundle strategy has a significant effect on the treatment of septic shock after urological surgery,which can stabilize the patient’s vital signs as soon as possible,relieve the symptoms of infection,and effectively avoid further damage to the organ function.