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普通病房脓毒症患者的液体复苏与初始管理

Fluid Resuscitation and Initial Management in Patients Presenting with Sepsis in the General Ward.

作者信息

Chang Sung Won, Choi Juwhan, Oh Jee Youn, Lee Young Seok, Min Kyung Hoon, Hur Gyu Young, Lee Sung Yong, Shim Jae Jeong, Sim Jae Kyeom

机构信息

Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea.

出版信息

Life (Basel). 2025 Jan 18;15(1):124. doi: 10.3390/life15010124.

Abstract

The optimal management of hospital-presenting sepsis remains poorly understood. We investigated the initial management in patients presenting with sepsis in the general ward, the association between fluid resuscitation and clinical outcomes, and the factors affecting fluid resuscitation. A retrospective study was conducted on patients who presented with sepsis-induced hypotension in the general ward. Patients were divided into Less 30 (fluid resuscitation less than 30 mL/kg) and More 30 (fluid resuscitation 30 mL/kg or more) groups. Multivariable logistic regression analysis was performed. The median resuscitation fluid volume was 500 mL (9.2 mL/kg) and 2000 mL (35.9 mL/kg) in the Less 30 ( = 79) and More 30 ( = 11) groups, respectively. The intensive care unit (ICU) mortality was similar between the two groups (43.0% vs. 45.5%). Twenty-two patients received continuous renal replacement therapy (CRRT) in the Less 30 group, whereas none received it in the More 30 group (27.8% vs. 0%). Fluid resuscitation ≥30 mL/kg was not associated with ICU mortality. Low body weight and systolic blood pressure were associated with fluid resuscitation ≥30 mL/kg. Most hospital-presenting sepsis patients received less than 30 mL/kg of fluid, and fluid resuscitation was not associated with ICU mortality.

摘要

对于在医院出现的脓毒症,其最佳管理方式仍知之甚少。我们调查了普通病房中脓毒症患者的初始管理、液体复苏与临床结局之间的关联以及影响液体复苏的因素。对普通病房中出现脓毒症诱发低血压的患者进行了一项回顾性研究。患者被分为少于30组(液体复苏量少于30 mL/kg)和多于30组(液体复苏量为30 mL/kg或更多)。进行了多变量逻辑回归分析。少于30组(n = 79)和多于30组(n = 11)的复苏液体量中位数分别为500 mL(9.2 mL/kg)和2000 mL(35.9 mL/kg)。两组的重症监护病房(ICU)死亡率相似(43.0%对45.5%)。少于30组中有22例患者接受了连续性肾脏替代治疗(CRRT),而多于30组中无患者接受(27.8%对0%)。液体复苏≥30 mL/kg与ICU死亡率无关。低体重和收缩压与液体复苏≥30 mL/kg有关。大多数在医院出现的脓毒症患者接受的液体量少于30 mL/kg,且液体复苏与ICU死亡率无关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/012e/11767154/9f21014441c5/life-15-00124-g001.jpg

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