关键词: 感染性休克, 利尿剂, 液体平衡, 病死率

Abstract:

Objective To investigate the relationship between the negative fluid balance and outcomes in patients with septic shock.Methods This was a retrospective controled study. Medical records of 41 patients admitted to our medical ICU over a 5 year period(1999.1～2003.12) were examined. Patients with septic shock who had renal failure or required dialysis prior to hospitalization were not included. A number of demographic and physiology variables were collected from the medical records, including age, gender, MAP, heart rate, respiratory rate, temperature, electrolyte(K⁺, Na⁺, Cl^-), pH, PaO₂/F_iO₂, Cr, Hct, WBC, HCO₃^- and the intake liquid, fluid balance of the first 3 days, furosemide doses, and so on. From the variables admission APACHE Ⅱ(acute physiology and chronic health evaluation) and daily sequential organ failure assessment(SOFA) scores were computed from the collected data. Variables were compared between survivors and nonsurvivors, and also between the patients who achieved negative(<0 mL) fluid balance in ≥1 day of the first 3 days of management and those who did not achieve negative(<0 mL) fluid balance in ≥1 day of the first 3 days of management. The Logistic regression statistics was used to determine the relationship between negative fluid balance, age, APACHE Ⅱ, SOFA scores on the first and third day and survival.Results Of the 41 patients, 29 died(<28 days), so the mortality was 71%. There was no significant difference in terms of the APACHE Ⅱ, SOFA score, age, gender, furosemide doses between survivors and nonsurvivors: so was also between patients who achieved negative(<0 mL) fluid balance in ≥1 day of the first 3 days of management and those who did not ten of 21 patients who achieved a negative balance of <0 mL on ≥1 day of the first 3 days of treatment survived, only 2 of 16 patients who failed to achieved a negative fluid balance of on ≥1 day of the first 3 days of treatment survived(52.38% vs 87.50%, χ²=5.303, P=0.021).Conclusion At least 1 day of net negative fluid balance in the first 3 days of treatment may be a good independent predictor for survival in patients with septic shock.

Key words: septic shock, diuretic, fluid balance, mortality