脓毒症1小时集束化治疗策略执行达标率及预后影响因素

Survey of qualified rate of excution of 1 h bundle treatment strategy for sepsis and the influencing factors of prognosis

目的探讨重症监护室(ICU)医务人员采用1小时集束化治疗策略(1 h bundle)救治脓毒症的执行情况,并分析脓毒症/感染性休克患者28 d预后影响因素.方法选择2019年6月-2022年7月新疆医科大学第一附属医院重症监护病房(ICU)、急诊重症监护病房(EICU)、呼吸重症监护病房(RICU)内符合脓毒症3.0定义与诊断标准患者,根据28 d预后情况分为生存组100例与死亡组91例,收集病原菌与感染部位、1 h bundle执行情况和28 d预后结局等资料;分析影响预后的危险因素并绘制受试者工作特征(ROC)曲线,进一步评估不同指标对脓毒症/感染性休克患者的预测价值.结果191例脓毒症/感染性休克患者共培养分离病原菌295株,其中革兰阴性菌212株占71.86%,革兰阳性菌50株占16.95%,真菌32株占10.85%;感染部位以肺部、腹腔和皮肤软组织为主;1 h bundle策略总体达标率为9.95%,两组达标率差异无统计学意义;28 d病死率为47.64%;年龄(AUC=0.620)、脓毒症相关序贯器官衰竭评分(SOFA)(AUC=0.730)、急性生理与慢性健康Ⅱ(APACHEⅡ)评分(AUC=0.662)、6 h乳酸(AUC=0.590)、24 h乳酸(AUC=0.681)是脓毒症/感染性休克患者28 d预后影响因素;ROC曲线结果显示,年龄、SOFA评分、APACHEⅡ评分、6 h乳酸、24 h乳酸对患者预后情况均有一定预测价值(P<0.05).结论本地区ICU内1 hbundle策略达标率不理想,应探寻行之有效策略提高对于循证指南执行率,进而有效降低脓毒症造成的威胁.

OBJECTIVE To investigate the implementation of 1-hour bundle treatment strategy(1 h bundle)for the management of sepsis by medical staff in the intensive care unit(ICU),and to analyze the factors affecting the 28-day prognosis of patients with sepsis/septic shock.METHODS Patients who met the definition and diagnostic criteria of sepsis 3.0 in the intensive care unit(ICU),emergency intensive care unit(EICU),and respiratory intensive care unit(RICU)of the First Affiliated Hospital of Xinjiang Medical University from Jun.2019 to Jul.2022 were selected and divided into 100 cases in the survival group and 91 cases in the death group according to the 28-day prognosis.The distribution characteristics and infection sites of pathogens,1 h bundle execution,and 28-day prog nosis were documented.Risk factors affecting prognosis were analyzed and receiver operating characteristic(ROC)curves were plotted to further assess the predictive value of different indicators for patients with sepsis/septic shock.RESULTS A total of 295 strains of pathogenic bacteria were cultured and isolated from 191 patients with sepsis/septic shock,of which 212 strains of Gram negative bacteria accounted for 71.86%,50 strains of Gram positive bacteria accounted for 16.95%,and 32 strains of fungi accounted for 16.75%.The main infection sites were the lungs,abdominal cavity,and skin soft tissues.The overall attainment rate of the 1-hour bundle strategy was 9.95%,with no statistically significant difference between the two groups.The 28 day mortality rate was 47.64%.Age(AUC=0.620),sepsis related sequential organ failure score(SOFA)(AUC=0.730),acute physiology and chronic health II(APACHEII)score(AUC=0.662),6-hour lactate(AUC=0.590),and 24-hour lactate(AUC=0.681)were influencing factors for the 28 day prognosis of sepsis/septic shock patients.The results of Receiver operating characteristic showed that age,SOFA score,APACHE II score,6 h lactate,24 h lactate had certain predictive value for the prognosis of patients(P<O.05).CONCLUSION The rate of compliance with 1 h bundle strategies in ICUs in this region was not satisfactory and effective strategies should be explored to improve the implementation of evidence-based guidelines,and thereby effectively reduce the threat of sepsis.