Ruangchan Sujinda, Chusri Sarunyou, Saengsanga Pornthip, Kiamkan Nongnuch, Phunpairoth Pakakrong, Chayakul Panthip
J Med Assoc Thai. 2016 Aug;99(8):877-85.
Severe sepsis and septic shock are the most common causes of in-hospital death in Songkhla Provincial Hospital and half of the patients are transferred from community hospitals. A simple severe sepsis and septic shock fast track had been implemented in all community hospitals in Songkhla Province and in Songkhla Provincial Hospital in December 2013.
Evaluate the clinical outcomes and predictors of mortality of severe sepsis and septic shock patients after implementation of the simple severe sepsis and septic shock fast track.
A retrospective study of all available medical records between December 2013 and May 2014 of hospitalized patients aged older than 15 years with a final diagnosis of severe sepsis or septic shock.
Of 723 patients diagnosed as community acquired sepsis, 228 (31.5%) patients were diagnosed with severe sepsis or septic shock. A simple severe sepsis and septic shock fast track were activated in 69.3%. Patients in the activated fast track group had significantly lower mortality than the non-activated fast track group (21.0% vs. 42.9%, p = 0.001). After adjusted analysis, the four independent risk factors associated with increased mortality in severe sepsis and septic shock were initial presentation with systolic blood pressure lower than 90 mmHg (adjusted odds ratio [aOR] 2.57), central nervous system failure (aOR 7.33), acute renal failure (aOR 5.07), and received norepinephrine (aOR 2.87). Two factors associated with a significant decrease in mortality were the simple fast track activated at the emergency department (aOR 0.22) or at the ward (aOR 0.09) and received appropriate initial antibiotics (aOR 0.09).
Early recognition and early resuscitation in case of severe sepsis and septic shock can reduce mortality. A simple severe sepsis and septic shock fast track should be implemented in all community hospitals. It is a simple clinical diagnosis with simple management that is possible in every community hospital before transfer to a secondary or tertiary care hospital.
严重脓毒症和脓毒性休克是宋卡府省医院院内死亡的最常见原因，且半数患者由社区医院转诊而来。2013年12月，宋卡府所有社区医院及宋卡府省医院实施了一项简单的严重脓毒症和脓毒性休克快速通道方案。
评估实施简单的严重脓毒症和脓毒性休克快速通道方案后，严重脓毒症和脓毒性休克患者的临床结局及死亡预测因素。
对2013年12月至2014年5月期间，年龄大于15岁、最终诊断为严重脓毒症或脓毒性休克的住院患者的所有可用病历进行回顾性研究。
在723例诊断为社区获得性脓毒症的患者中，228例（31.5%）被诊断为严重脓毒症或脓毒性休克。69.3%的患者启动了简单的严重脓毒症和脓毒性休克快速通道。启动快速通道组患者的死亡率显著低于未启动快速通道组（21.0%对42.9%，p = 0.001）。经校正分析，与严重脓毒症和脓毒性休克死亡率增加相关的四个独立危险因素为：初始收缩压低于90 mmHg（校正比值比[aOR] 2.57）、中枢神经系统功能衰竭（aOR 7.33）、急性肾衰竭（aOR 5.07）以及使用去甲肾上腺素（aOR 2.87）。与死亡率显著降低相关的两个因素为：在急诊科（aOR 0.22）或病房（aOR 0.09）启动简单快速通道以及使用适当的初始抗生素（aOR 0.09）。
严重脓毒症和脓毒性休克时的早期识别和早期复苏可降低死亡率。所有社区医院均应实施简单的严重脓毒症和脓毒性休克快速通道方案。这是一种简单的临床诊断及管理方法，在每个社区医院于转诊至二级或三级医疗机构之前即可实施。
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