在急诊科开始早期目标导向治疗的严重脓毒症或感染性休克患者中，抗生素使用时间对生存的影响。

Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department.

机构信息

Department of Emergency Medicine, Division of Pulmonary, Allergy, and Critical Care, the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.

出版信息

Crit Care Med. 2010 Apr;38(4):1045-53. doi: 10.1097/CCM.0b013e3181cc4824.

DOI:10.1097/CCM.0b013e3181cc4824

PMID:20048677

Abstract

OBJECTIVE

To study the association between time to antibiotic administration and survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department.

DESIGN

Single-center cohort study.

SETTING

The emergency department of an academic tertiary care center from 2005 through 2006.

PATIENTS

Two hundred sixty-one patients undergoing early goal-directed therapy.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Effects of different time cutoffs from triage to antibiotic administration, qualification for early goal-directed therapy to antibiotic administration, triage to appropriate antibiotic administration, and qualification for early goal-directed therapy to appropriate antibiotic administration on in-hospital mortality were examined. The mean age of the 261 patients was 59 +/- 16 yrs; 41% were female. In-hospital mortality was 31%. Median time from triage to antibiotics was 119 mins (interquartile range, 76-192 mins) and from qualification to antibiotics was 42 mins (interquartile range, 0-93 mins). There was no significant association between time from triage or time from qualification for early goal-directed therapy to antibiotics and mortality when assessed at different hourly cutoffs. When analyzed for time from triage to appropriate antibiotics, there was a significant association at the <1 hr (mortality 19.5 vs. 33.2%; odds ratio, 0.30 [95% confidence interval, 0.11-0.83]; p = .02) time cutoff; similarly, for time from qualification for early goal-directed therapy to appropriate antibiotics, a significant association was seen at the < or =1 hr (mortality 25.0 vs. 38.5%; odds ratio, 0.50 [95% confidence interval, 0.27-0.92]; p = .03) time cutoff.

CONCLUSIONS

Elapsed times from triage and qualification for early goal-directed therapy to administration of appropriate antimicrobials are primary determinants of mortality in patients with severe sepsis and septic shock treated with early goal-directed therapy.

摘要

目的

研究在急诊科开始早期目标导向治疗的严重脓毒症或感染性休克患者中，抗生素治疗开始时间与生存之间的关系。

设计

单中心队列研究。

地点

2005 年至 2006 年期间某学术三级保健中心的急诊科。

患者

261 例接受早期目标导向治疗的患者。

干预措施

无。

测量和主要结果

考察了分诊至抗生素给药、早期目标导向治疗符合抗生素给药标准至抗生素给药、分诊至适当抗生素给药和早期目标导向治疗符合抗生素给药标准至适当抗生素给药的不同时间截止值对住院死亡率的影响。261 例患者的平均年龄为 59±16 岁；41%为女性。院内死亡率为 31%。从分诊到抗生素的中位时间为 119 分钟（四分位间距，76-192 分钟），从符合早期目标导向治疗标准到抗生素的中位时间为 42 分钟（四分位间距，0-93 分钟）。在不同小时截止值下，从分诊或从早期目标导向治疗符合抗生素给药标准到抗生素给药的时间与死亡率之间无显著相关性。当分析从分诊到适当抗生素的时间时，在<1 小时（死亡率 19.5%比 33.2%；优势比，0.30[95%置信区间，0.11-0.83]；p=0.02）的时间截止值有显著相关性；同样，对于从早期目标导向治疗符合抗生素给药标准到适当抗生素的时间，在<或=1 小时（死亡率 25.0%比 38.5%；优势比，0.50[95%置信区间，0.27-0.92]；p=0.03）的时间截止值有显著相关性。