Department of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China.
Department of Intensive Care Unit, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, People's Republic of China.
Surg Infect (Larchmt). 2021 Apr;22(3):340-346. doi: 10.1089/sur.2019.370. Epub 2020 Aug 3.
The relation between deresuscitative fluid management after the resuscitation phase and clinical outcome in patients with abdominal sepsis is not completely clear. The aim of this study was to assess the contribution of deresuscitative management to death and organ dysfunction in abdominal sepsis. Consecutive patients with abdominal sepsis requiring fluid resuscitation were included in this study. According to the fluid management given in the later stage of resuscitation, a conservative group and a deresuscitative fluid management group were compared. The primary outcome was in-hospital death, whereas secondary outcomes were categorized as organ dysfunction and other adverse events. A total of 138 patients were enrolled in this study. Conservative fluid management was given to 47.8% of patients, whereas deresuscitative fluid management occurred in 52.2%. The deresuscitative strategy was associated with a markedly lower prevalence of new-onset acute kidney injury and a decrease in the duration of continuous renal replacement therapy (CRRT). There was a greater risk of needing new-onset intubation and the mechanical ventilation duration in the conservative group than in the deresuscitative group. However, the deresuscitative group did not differ from the conservative group with respect to open abdomen and intra-abdominal hypertension or new-onset abdominal compartment syndrome. The conservative treatment was associated with prolonged stays as well as a higher in-hospital mortality rate. A multivariable logistic regression model showed that deresuscitative fluid management imparts a protective effect against in-hospital death (odds ratio 4.343; 95% confidence interva1 1.466-12.866; p = 0.008), whereas septic shock, source control failure, and CRRT duration were associated with a higher mortality rate. Fluid balance achieved using deresuscitative treatment is correlated with better outcomes in patients with abdominal sepsis, indicating that this treatment may be useful as a therapeutic strategy.
在复苏阶段后进行的复苏液管理与腹部脓毒症患者的临床结局之间的关系尚不完全清楚。本研究的目的是评估复苏后期复苏液管理对腹部脓毒症患者死亡和器官功能障碍的影响。
本研究纳入了需要液体复苏的连续腹部脓毒症患者。根据复苏后期给予的液体管理，将患者分为保守治疗组和复苏液管理组。主要结局是院内死亡，次要结局分为器官功能障碍和其他不良事件。
共有 138 例患者纳入本研究。47.8%的患者接受了保守的液体管理，而 52.2%的患者接受了复苏液管理。复苏策略与新发急性肾损伤的发生率显著降低以及持续肾脏替代治疗（CRRT）时间缩短有关。与复苏组相比，保守组发生新插管和机械通气时间的风险更大。然而，在开放腹部和腹腔高压或新发腹腔间隔室综合征方面，保守组与复苏组无差异。保守治疗与住院时间延长和院内死亡率升高有关。多变量逻辑回归模型显示，复苏液管理对院内死亡具有保护作用（比值比 4.343；95%置信区间 1.466-12.866；p=0.008），而感染性休克、源头控制失败和 CRRT 时间与死亡率升高有关。
使用复苏治疗实现的液体平衡与腹部脓毒症患者的更好结局相关，表明这种治疗可能是一种有用的治疗策略。
