Department of Emergency Medicine, Beijing Shijitan Hospital, Beijing 100038, China.
Chin Med J (Engl). 2010 Dec;123(24):3550-3.
Patients with septic shock have a high mortality. This study used the Surviving Sepsis Campaign (SSC) database to compare characteristics, treatments and outcomes of septic shock patients diagnosed in the emergency department (ED) to patients developing septic shock on hospital floors (HF).
The studied population included patients admitted to the intensive care unit (ICU) of an urban tertiary care medical center over an 18-month period. Acute physiology and chronic health evaluation (APACHE II) scores, need for mechanical ventilation (MV), performance on four of the SSC resuscitation bundle indicators, ICU length of stay (LOS), hospital LOS and in-hospital mortality were ascertained.
Sixty-six ED and 27 HF septic shock patients were included in this study. Urinary tract infections (UTI) and pneumonia were the two most common sites of infection in the ED patients. The sources of infection for HF septic shock patients were fairly well distributed across etiologies. The time to achieve superior vena cava oxygen saturation (ScvO(2)) > 70% in HF patients ((10.8 ± 9.1) hours) was longer when compared to the ED patients ((6.6 ± 6.1) hours) (P < 0.05). Hospital mortality for the ED and HF patients were 25.8% and 59.3%, respectively (P < 0.05). Use of MV during the first 24 hours of shock was 44% in the ED patients and 70% in the HF patients (P < 0.05) and was linked to mortality.
When compared to HF patients, ED septic shock patients have lower in-hospital mortality, there was less use of MV during the first 24 hours following onset of septic shock and the HF patients required a longer time to achieve target ScvO(2). The need for mechanical ventilation is independently associated with increased mortality.
感染性休克患者的死亡率较高。本研究利用拯救脓毒症运动（SSC）数据库，比较了在急诊科（ED）确诊的感染性休克患者与在医院病房（HF）发生感染性休克的患者的特征、治疗方法和结局。
研究人群包括在 18 个月内入住城市三级医疗中心重症监护病房（ICU）的患者。评估急性生理学和慢性健康评估（APACHE II）评分、机械通气（MV）需求、SSC 复苏捆绑指标中的四项的完成情况、ICU 住院时间（LOS）、医院 LOS 和院内死亡率。
本研究纳入了 66 例 ED 感染性休克患者和 27 例 HF 感染性休克患者。尿路感染（UTI）和肺炎是 ED 患者最常见的感染部位。HF 感染性休克患者的感染源在病因学上分布较为均匀。HF 患者达到上腔静脉血氧饱和度（ScvO2）>70%的时间（10.8±9.1）小时比 ED 患者（6.6±6.1）小时更长（P<0.05）。ED 和 HF 患者的院内死亡率分别为 25.8%和 59.3%（P<0.05）。在休克发生后的前 24 小时内，ED 患者中使用 MV 的比例为 44%，HF 患者为 70%（P<0.05），并且与死亡率相关。
与 HF 患者相比，ED 感染性休克患者的院内死亡率较低，在感染性休克发生后的前 24 小时内使用 MV 的比例较低，HF 患者达到目标 ScvO2 的时间更长。机械通气的需求与死亡率的增加独立相关。
