Zhu Ying, Tao Ran-jun, Shi Wen, Tong Jian-jing, Lu Yi-ming
Department of Emergency of Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2011 Mar;23(3):138-41.
To evaluate the occurrence of severe sepsis and septic shock and the rate of compliance with sepsis bundle in patients with severe sepsis and septic shock in emergency department.
A prospective study was conducted on consecutive adult patients who were sent to Emergency Department of Ruijin Hospital, Shanghai Jiaotong University School of Medicine by ambulance from May to June in 2009. The occurrence of severe sepsis and septic shock, and the number of the patients in whom who met the criteria of compliance with sepsis bundle were analyzed.
Nine hundred and seventeen patients who were sent to the emergency department by ambulance in that period were enrolled in the study. The number of patients with severe sepsis and septic shock was 96. The incidence of severe sepsis and septic shock was 10.47%. Among these patients, the number of patients in whom the sepsis bundle was complied, i.e. sepsis bundle, appropriate cultures were taken before antimicrobial therapy, placement of central venous catheter and monitoring of central venous pressure (CVP) as well as central venous oxygen saturation (ScvO₂) within 2 hours, antibiotic therapy within 3 hours, early goal directed therapy (EGDT) within 6 hours, and lactate clearance in 12 hours reached 1.04%, 3.12%, 2.08%, 83.33%, 1.04%, 23.96%. The Results were 1.19%, 3.57%, 2.38%, 83.33%, 1.19%, 26.19% and 0, 0, 0, 83.33%, 0, 8.33% in medical and surgical emergency department respectively. There was no statistical difference between the two divisions (all P>0.05).
The incidence of severe sepsis and septic shock was high in emergency department, but the rate of recognition of it and the compliance with sepsis bundle were inadequate. It is urgently necessary to enhance the learning and implementation of the guideline.
评估急诊科严重脓毒症和脓毒性休克的发生率以及脓毒症集束化治疗的依从率。
对2009年5月至6月由救护车送至上海交通大学医学院附属瑞金医院急诊科的成年连续患者进行前瞻性研究。分析严重脓毒症和脓毒性休克的发生情况以及符合脓毒症集束化治疗标准的患者数量。
该时期内917例由救护车送至急诊科的患者纳入研究。严重脓毒症和脓毒性休克患者96例，发生率为10.47%。这些患者中，符合脓毒症集束化治疗标准，即脓毒症集束化治疗、在抗菌治疗前采集合适的培养标本、在2小时内放置中心静脉导管并监测中心静脉压（CVP）以及中心静脉血氧饱和度（ScvO₂）、在3小时内进行抗生素治疗、在6小时内进行早期目标导向治疗（EGDT）以及在12小时内实现乳酸清除的患者比例分别为1.04%、3.12%、2.08%、83.33%、1.04%、23.96%。在内科和外科急诊科的结果分别为1.19%、3.57%、2.38%、83.33%、1.19%、26.19%以及0、0、0、83.33%、0、8.33%。两个科室之间无统计学差异（所有P>0.05）。
急诊科严重脓毒症和脓毒性休克的发生率较高，但对其的识别率和脓毒症集束化治疗的依从率不足。迫切需要加强指南的学习与实施。
