Chen Zhong-qing, Jin Ying-hui, Chen Hui, Fu Wei-jun, Yang Hong, Wang Rui-ting
Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2007 Dec;27(12):1892-5.
To investigate the effect of early goal-directed therapy (EGDT) on the incidence, severity and mortality of multiple organ dysfunction syndrome (MODS).
A prospective, randomized controlled trial was performed involving 273 patients in the early stage of shock at risk of potential MODS development. The patients were randomly divided into EGDT group (including 139 patients managed with EGDT) and control group (including 134 patients with conventional empirical therapy). The scores of APACHE II, blood lactate concentration (Lactate(0)) and SOFA scores (SOFA(0)) of the two groups were recorded on admission, and the lactate concentration on the second and fourth day of hospitalization (Lactate(2) and Lactate(4)), and the highest SOFA scores (SOFAT) after admission were also recorded. The discrepancy between the two SOFA scores (SOFA(S)), number of the dysfunctional organ, and the mortality in ICU of the two groups were calculated at the end of the study.
The incidence of MODS in the EGDT group was significantly lower than that in control group (P=0.002). The Lactate(2), Lactate(4), SOFA(T), SOFA(S), and the number of dysfunctional organs in EGDT group were also significantly lower (P=0.045, 0.016, 0.009, 0.010, 0.002). EGDT was associated with a significantly lower total mortality rate of MODS than the conventional therapy (P=0.007), and also with a significantly lower mortality rate of MODS after controlling for severe sepsis (P=0.047 and 0.044).
EGDT can decrease the incidence and severity of MODS, and can effectively decrease the mortality of MODS irrespective of the presence of severe sepsis.
探讨早期目标导向治疗（EGDT）对多器官功能障碍综合征（MODS）发病率、严重程度及死亡率的影响。
进行一项前瞻性随机对照试验，纳入273例处于休克早期且有发生潜在MODS风险的患者。患者被随机分为EGDT组（139例接受EGDT治疗）和对照组（134例接受传统经验性治疗）。记录两组患者入院时的急性生理与慢性健康状况评分系统II（APACHE II）、血乳酸浓度（Lactate(0)）和序贯器官衰竭评估（SOFA）评分（SOFA(0)），以及住院第2天和第4天的乳酸浓度（Lactate(2)和Lactate(4)），还有入院后最高SOFA评分（SOFAT）。在研究结束时计算两组SOFA评分差值（SOFA(S)）、功能障碍器官数量及重症监护病房（ICU）死亡率。
EGDT组MODS发病率显著低于对照组（P = 0.002）。EGDT组的Lactate(2)、Lactate(4)、SOFA(T)、SOFA(S)及功能障碍器官数量也显著更低（P = 0.045、0.016、0.009、0.010、0.002）。与传统治疗相比，EGDT使MODS总死亡率显著降低（P = 0.007），在控制严重脓毒症后，EGDT也使MODS死亡率显著降低（P = 0.047和0.044）。
EGDT可降低MODS的发病率和严重程度，且无论是否存在严重脓毒症，均可有效降低MODS的死亡率。
