Chen Qi-hong, Zheng Rui-qiang, Lin Hua, Lu Nian-fang, Shao Jun, Yu Jiang-quan, Dou Ying-ru, WANG Hua-ling
Department of Intensive Care Unit, Subei Hospital of Jiangsu Province, Clinical Medical School, Yangzhou University, Yangzhou 225001, Jiangsu, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2011 Mar;23(3):142-5.
To find out the influential effect of different fluid management on mortality of patients with septic shock in different phases.
From March 2007 to December 2009, a retro spective controlled study was conducted on the clinical data of 107 adult patients with septic shock in the intensive care unit (ICU) of Subei Hospital of Jiangsu Province. The patients were divided into survival group ( n =68) and non survival group ( n =39) according to the final outcome. A number of demographic and variables were collected from the medical record. The acute physiology and chronic health evaluationII (APACHEII) score, sequential organ failure assessment (SOFA), liquid intake and output volume and its balance daily within 1 week, 24 hour early goal directed therapy (EGDT) and conservative late fluid management (CLFM) were compared between two groups. The Logistic regression statistics was used to determine the relationship between APACHEII, SOFA, EGDT, CLFM and survival.
The single variable analysis showed that there was significant difference in the parameters of oxygenation index in 7 days ,arterial blood lactate clearance within 24 hours, acute lung injury, length of mechanical ventilation, length of ICU stay and in hospital, the goal of fluid management including 24 hour EGDT, 24 hour CLFM, fluid balance in 24 hours, total fluid input within 7 days, negative fluid balance and times during 7 days between two groups. Logistic regression showed that failure to achieve 24 hour EGDT and late CLFM,a negative balance of <2 000 ml, total fluid input of >20 000 ml within 1 week were independent risk factors of death, and odds ratio ( OR ) was 4.159, 4.431, 23.788 and 4.353, respectively, the P value was 0.035, 0.019, 0.000, 0.025, respectively. The 28 day mortality in 24 hour EGDT and CLFM group (12.5%) was significantly lower than that of 24 hour EGDT with liberal late fluid management (LLFM) group (46.2%) and that in the group of patients in whom with failure to have 24 hour EGDT with CLFM or LLFM (30.0%, 76.2%, P<0.05 or P <0.01).
Both early achievement of 24 hour EGDT and late CLFM for the patients with septic shock can lower mortality.
探讨不同液体管理方式对不同阶段感染性休克患者死亡率的影响。
回顾性分析2007年3月至2009年12月江苏省苏北医院重症监护病房（ICU）收治的107例成年感染性休克患者的临床资料。根据最终结局将患者分为存活组（n = 68）和非存活组（n = 39）。从病历中收集一些人口统计学和变量数据。比较两组患者的急性生理与慢性健康状况评分系统II（APACHEII）评分、序贯器官衰竭评估（SOFA）、1周内每日液体出入量及其平衡、24小时早期目标导向治疗（EGDT）和保守性晚期液体管理（CLFM）情况。采用Logistic回归统计分析确定APACHEII、SOFA、EGDT、CLFM与存活之间的关系。
单因素分析显示，两组患者在7天氧合指数、24小时动脉血乳酸清除率、急性肺损伤、机械通气时间、ICU住院时间和住院时间等参数，以及液体管理目标包括24小时EGDT、24小时CLFM、24小时液体平衡、7天内总液体入量、负液体平衡及7天内次数等方面存在显著差异。Logistic回归分析显示，未达到24小时EGDT和晚期CLFM、负平衡<2000 ml、1周内总液体入量>20000 ml是死亡的独立危险因素，比值比（OR）分别为4.159、4.431、23.788和4.353，P值分别为0.035、0.019、0.000、0.025。24小时EGDT联合CLFM组的28天死亡率（12.5%）显著低于24小时EGDT联合宽松晚期液体管理（LLFM）组（46.2%），以及未进行24小时EGDT联合CLFM或LLFM组（30.0%、76.2%，P<0.05或P<0.01）。
感染性休克患者早期实现24小时EGDT和晚期CLFM均可降低死亡率。
