1h、3h与6h集束化治疗完成情况对感染性休克患者近期预后的影响

Effect of 1-h,3-h and 6-h cluster therapy on the short-term prognosis of patients with septic shock

目的 探讨1 h、3 h与6 h集束化治疗完成情况对感染性休克患者近期预后的影响。方法 选取感染性休克患者249例的病例资料进行回顾性研究。收集入组患者的基础资料及病理资料,根据预后结局将其分为死亡组和生存组。分析2组间1 h、3 h与6 h集束化治疗完成情况,通过Logistic多因素回归分析筛查感染性休克患者预后的影响因素。结果 249例感染性休克患者中28 d死亡74例,病死率为29.72%。其中1 h、3 h、6 h集束化治疗完成病例分别为18例(24.32%)、44例(59.46%)、12例(16.22%)。生存175例(70.28%)。死亡组急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分高于生存组,抗生素开始使用时间晚于生存组,1 h集束化治疗完成、乳酸值升高重新评估、中心静脉压值正常占比低于生存组(P<0.05)。Logistic多因素回归分析结果显示,APACHEⅡ评分(OR=3.777,95%CI:2.133~6.689)、抗生素使用时间(OR=3.053,95%CI:1.723~5.406)、乳酸值升高重新评估(OR=0.337,95%CI:0.185~0.613)、1 h集束化治疗完成(OR=0.404,95%CI:0.219~0.745)、中心静脉压值正常(OR=0.291,95%CI:0.165~0.511)均为感染性休克预后的影响因素(P<0.05)。结论 完成1 h集束化治疗有助于改善感染性休克患者的近期预后。

Objective To explore the effect of 1-h,3-h and 6-h cluster therapy on the short-term prognosis of patients with septic shock.Methods A retrospective study was conducted on case data of 249 patients with septic shock.Baseline characteristics and pathological data of enrolled patients were collected and categorized into survival and non-survival groups based on prognosis outcomes.The completion status of 1-h,3-h and 6-h cluster therapy between the two groups was analyzed.Logistic multivariate regression analysis was performed to screen for prognostic factors of patients with septic shock.Results Among the 249 patients with septic shock,there were 74 deaths within 28 days,resulting in a mortality rate of 29.72%.Specifically,the number of patients with completion rates of 1-h,3-h,and 6-h cluster therapy were 18(24.32%),44(59.46%),and 12(16.22%),respectively.Survival was observed in 175(70.28%)patients.In the non-survival group,the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score was higher,and the initiation of antibiotic use was later compared with that of the survival group.Additionally,the proportion of patients with completion of 1-h cluster therapy,reevaluation of elevated lactate levels,and normal central venous pressure values was lower than that in the survival group(P<0.05).The results of multivariate Logistic regression analysis indicated that APACHEⅡscore(OR=3.777,95%CI:2.133-6.689),duration of antibiotic use(OR=3.053,95%CI:1.723-5.406),reevaluation of elevated lactate levels(OR=0.337,95%CI:0.185-0.613),completion of 1-h cluster therapy(OR=0.404,95%CI:0.219-0.745),and normal central venous pressure values(OR=0.291,95%CI:0.165-0.511)were all factors influencing the prognosis of patients with septic shock(P<0.05).Conclusion The completion of 1 h cluster therapy is helpful to improve the short-term prognosis of patients with septic shock.