脓毒症患者集束化治疗后液体平衡状态对预后的影响
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摘要
目的探讨脓毒症患者集束化治疗液体复苏后1周内液体平衡状态对临床预后的影响。方法采用回顾性队列研究方法,选择2016年1月至2016年12月苏州大学附属第二医院重症监护病房(ICU)脓毒症及脓毒性休克患者,按治疗后28d预后情况分为生存组及死亡组,比较两组患者的一般基线资料并倾向性评分匹配后,再比较两组患者间7d内每日出入量、平衡量及累计液体平衡量。结果 102例脓毒症及脓毒性休克患者中,28d死亡率为28.43%(29/102)。两组患者在第3～7天的液体平衡量、第4～7天的累计液体平衡量比较,差异有统计学意义(P<0.05)。结论对于脓毒症及脓毒性休克患者早期集束化复苏治疗后,在满足机体重要脏器灌注条件下,尽早达到液体负平衡状态可降低病死率。
Objective To analyze the effect of fluid balance after sepsis bundle with fluid resuscitation in 1 week on clinical prognosis in patients with sepsis.Methods We performed a retrospective cohort study on the patients with sepsis and septic shock at the second affiliated hospital of Soochow University between January,2016 and December,2016.Patients were categorized into the non-survivor and survivor group based on 28-day mortality.After comparing the general baseline data and matching the propensity score in the two groups,daily intake,liquid equilibrium and cumulative liquid equilibrium within 7 days were compared.Results Of the102 sepsis and septic shock patients,28-day mortality was 28.43%(29/102).There were statistically significant differences between the two groups in liquid equilibrium in 3-7 days and cumulative liquid equilibrium in4-7 days(P<0.05).Conclusion For the sepsis and septic shock patients after sepsis bundle,if the perfusion condition of vital organ is satisfied,achieving negative liquid equilibrium as early as possible will reduce the mortality.
Objective To analyze the effect of fluid balance after sepsis bundle with fluid resuscitation in 1 week on clinical prognosis in patients with sepsis.Methods We performed a retrospective cohort study on the patients with sepsis and septic shock at the second affiliated hospital of Soochow University between January,2016 and December,2016.Patients were categorized into the non-survivor and survivor group based on 28-day mortality.After comparing the general baseline data and matching the propensity score in the two groups,daily intake,liquid equilibrium and cumulative liquid equilibrium within 7 days were compared.Results Of the102 sepsis and septic shock patients,28-day mortality was 28.43%(29/102).There were statistically significant differences between the two groups in liquid equilibrium in 3-7 days and cumulative liquid equilibrium in4-7 days(P<0.05).Conclusion For the sepsis and septic shock patients after sepsis bundle,if the perfusion condition of vital organ is satisfied,achieving negative liquid equilibrium as early as possible will reduce the mortality.
引文
[1]RHODES A,EVANS L E,ALHAZZANI W,et al.Surviving Sepsis Campaign:International Guidelines for Management of Sepsis and Septic Shock:2016[J].Critical care medicine,2017,45(3):486-552.
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[3]COHEN J,VINCENT J L,ADHIKARI N K,et al.Sepsis:a roadmap for future research[J].Lancet Infect Diseases,2015,15(5):581-614.
[4]SEYMOUR C W,ROSENGART M R.Septic shock:advances in diagnosis and treatment[J].JAMA,2015,314(7):708-717.
[5]PERNER A,VIEILLARD-BARON A,BAKKER J.Fluid resuscitation in ICU patients:quo vadis[J].Intensive Care Med,2015,41(9):1667-1669.
[6]MYBURGH J A,MYTHEN M G.Resuscitation fluids[J].N Engl J Med,2013,369(13):1243-1251.
[7]DELLINGER R P,LEVY M M,RHODES A,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock,2012[J].Intensive Care Med,2013,39(2):165-228.
[8]BOYD J H,FORBES J,NAKADA T A,et al.Fluid resuscitation in septic shock:apositive fluid balance and elevated central venous pressure are associated with increased mortality[J].Critical Care Med,2011,39(2):259-265.
[9]HJORTRUP P B,HAASE N,BUNDGAARD H,et al.Restricting volumes of resuscitation fluid in adults with septic shock after initial management:the CLASSIC randomised,parallel-group,multicentre feasibility trial[J].Intensive Care Med,2016,42(11):1695-1705.
[10]OSPINA-TASCON G,NEVES A P,OCCHIPINTI G,et al.Effects of fluids on microvascular perfusion in patients with severe sepsis[J].Intensive Care Med,2010,36(6):949-955.
[11]VINCENT J L,DE BACKER D.Circulatory shock[J].NEngl J Med,2013,369(18):1726-1734.
[12]ACHEAMPONG A,VINCENT J L.A positive fluid balance is an independent prognostic factor in patients with sepsis[J].Crit Care,2015,19(1):251-258.
[13]CRAIG M,DANIEL D B,CLIFFORD S,et al.Surviving sepsis campaign:research priorities for sepsis and septic shock[J].Intensive Care Med,2018,44(9):1400-1426.
[14]刘红梅,孙海晨.创伤性休克复苏的研究进展[J].创伤外科杂志,2011,13(1):78-81.
[15]徐颖,顾勤.液体管理对感染性休克合并急性肺损伤患者预后的影响[J].医学研究生学报,2012,25(7):738-741.
[2]蔡国荣,严静,邱海波.中国严重脓毒症/脓毒性休克治疗指南(2014)[J].中华内科杂志,2015,54(6):557-581.
[3]COHEN J,VINCENT J L,ADHIKARI N K,et al.Sepsis:a roadmap for future research[J].Lancet Infect Diseases,2015,15(5):581-614.
[4]SEYMOUR C W,ROSENGART M R.Septic shock:advances in diagnosis and treatment[J].JAMA,2015,314(7):708-717.
[5]PERNER A,VIEILLARD-BARON A,BAKKER J.Fluid resuscitation in ICU patients:quo vadis[J].Intensive Care Med,2015,41(9):1667-1669.
[6]MYBURGH J A,MYTHEN M G.Resuscitation fluids[J].N Engl J Med,2013,369(13):1243-1251.
[7]DELLINGER R P,LEVY M M,RHODES A,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock,2012[J].Intensive Care Med,2013,39(2):165-228.
[8]BOYD J H,FORBES J,NAKADA T A,et al.Fluid resuscitation in septic shock:apositive fluid balance and elevated central venous pressure are associated with increased mortality[J].Critical Care Med,2011,39(2):259-265.
[9]HJORTRUP P B,HAASE N,BUNDGAARD H,et al.Restricting volumes of resuscitation fluid in adults with septic shock after initial management:the CLASSIC randomised,parallel-group,multicentre feasibility trial[J].Intensive Care Med,2016,42(11):1695-1705.
[10]OSPINA-TASCON G,NEVES A P,OCCHIPINTI G,et al.Effects of fluids on microvascular perfusion in patients with severe sepsis[J].Intensive Care Med,2010,36(6):949-955.
[11]VINCENT J L,DE BACKER D.Circulatory shock[J].NEngl J Med,2013,369(18):1726-1734.
[12]ACHEAMPONG A,VINCENT J L.A positive fluid balance is an independent prognostic factor in patients with sepsis[J].Crit Care,2015,19(1):251-258.
[13]CRAIG M,DANIEL D B,CLIFFORD S,et al.Surviving sepsis campaign:research priorities for sepsis and septic shock[J].Intensive Care Med,2018,44(9):1400-1426.
[14]刘红梅,孙海晨.创伤性休克复苏的研究进展[J].创伤外科杂志,2011,13(1):78-81.
[15]徐颖,顾勤.液体管理对感染性休克合并急性肺损伤患者预后的影响[J].医学研究生学报,2012,25(7):738-741.