摘要
目的探究液体复苏完成时间及液体负平衡量对脓毒性休克患者预后的影响。方法选取2020年4月—2023年4月张家口市第一医院在重症科收治的脓毒症休克患者84例,予以30 mL/kg液体复苏治疗。分别根据液体复苏完成时间及液体负平衡量进行分组,记录患者的APACHEII评分、序贯器官衰竭评分(SOFA)、血乳酸、机械通气时间、连续性肾脏替代治疗占比、急性肾损伤发生率、急性呼吸窘迫综合征发生率、多器官功能障碍发生率及28 d病死率。结果不同时间完成液体复苏脓毒症患者的预后状况分析:1 h<T<3 h组患者液体复苏3 h后SOFA评分低于T≤1 h组、T≥3 h组(P<0.05)。各组患者的28 d病死率比较,1 h<T<3 h组患者的28 d病死率最低,T≤1 h组患者的28 d病死率最高,差异有统计学意义(P<0.05)。各组生存曲线分析比较,差异有统计学意义(P<0.05)。不同液体负平衡量脓毒症患者的预后状况分析:V<500 mL/24 h组患者液体复苏3 h后SOFA评分低于V≥500 mL/24 h组(P<0.05)。V<500 mL/24 h组患者的28 d病死率低于V≥500 mL/24 h组(P<0.05)。两组生存曲线分析比较,差异有统计学意义(P<0.05)。Cox回归分析显示,液体复苏3 h后SOFA评分、液体负平衡量、液体复苏完成时间是脓毒症休克患者预后生存的影响因素(P<0.05)。结论脓毒症休克患者在1~3 h内完成液体复苏,且液体复苏后维持<500 mL/24 h的液体负平衡量,有助于降低患者的28 d病死率。
Objective To explore the impact of fluid resuscitation completion time and negative fluid balance on the prognosis of patients with septic shock.Methods Eighty-four patients with septic shock treated with 30 ml/kg liquid resuscitation who were admitted to the Department of Intensive Care Unit of Zhangjiakou First Hospital from April 2020 to April 2023 were conducted to this study.All patients were divided into groups according to the completion time of fluid resuscitation(T)and the amount of negative fluid balance(V).The APACHEII score;sequential organ failure score(SOFA);blood lactic acid;mechanical ventilation time;the proportion of continuous renal replacement therapy;the incidence of acute kidney injury;the incidence of acute respiratory distress syndrome;the incidence of multiple organ dysfunction,and the 28 day mortality rate were recorded and analyzed.Results There were three groups according to T:T≤1 h group;1 h<T<3 h group;T≥3 h group.The SOFA score of patients in 1 h<T<3 h group was lower than that of the T≤1 h group and T≥3 h group(P<0.05).1 h<T<3 h group had the lowest 28-day mortality rate;while T≤1 h group had the highest 28 day mortality rate,there was a statistically significant difference(P<0.05)as compared with each group.The survival curves of each group were analyzed and compared,and the differences were statistically significant(P<0.05).There were two groups according V:V<500 mL/24 h group and V≥500 mL/24 h group.The SOFA score of patients in the V<500 mL/24 h group after fluid resuscitation for 3 hours was lower than that in the V≥500 mL/24 h group(P<0.05).The 28 day mortality rate of patients in the V<500 mL/24 h group was lower than that in the V≥500 mL/24 h group P<0.05).There was a statistically significant differences in the survival curve analysis between the two groups(P<0.05).Cox regression analysis showed that the SOFA score,negative fluid balance,and completion time of fluid resuscitation 3 hours after fluid resuscitation were factors for the prognosis and survival of the patients with septic shock(P<0.05).Conclusion Patients with septic shock in this study complete fluid resuscitation within 1-3 hours,and maintain a negative fluid balance of<500 mL/24h after fluid resuscitation,which helps reduce the patient's 28-day mortality.
作者
程晓宇
王紫薇
要丽琴
CHENG Xiaoyu;WANG Ziwei;YAO Liqin(Zhangjiakou First Hospital,Zhangjiakou Hebei 075000,China)
出处
《中国急救复苏与灾害医学杂志》
2024年第4期450-453,560,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
河北省医学科学研究课题项目(编号:20191725)。
关键词
脓毒性休克
液体复苏
完成时间
液体负平衡量
28
d病死率
Septic shock
Liquid resuscitation
Completion time
Liquid negative equilibrium quantity
28-day mortality rate
