关键词: 感染性休克, 早期目标治疗, 病死率

Abstract:

Objective The purpose of this study is to observe if the early bundle therapy can improve the outcome in patients with septic shock.Methods Thirty-three patients with septic shock in ICU of Fuxing Hospital from 2004 to 2007 have been enrolled, they were divided into two groups at the cut-point of Jan 1st 2006. The 15 patients from Jan 1st 2006 to Mar 1st 2007 were treated with the bundle therapy as a study group, the other 18 patients from Nov 1st 2004 to Jan 1st 2006 were given the routine therapy as a control group. According to the surviving sepsis campaign(SSC)guideline, the bundle therapy included the following: early goal-directed therapy (EGDT), early(within 1 hour after diagnosis) empirical use of broad-spectrum and effective antibiotics, blood glucose control, small-dose intravenous corticosteroid. The baseline data such as age, gender, acute physiology and chronic health evaluation(APACHE Ⅱ), sepsis-related organ failure assessment(SOFA), the initial central venous pressure(CVP), and CVP monitor changes before and after therapy, the changes in arterial serum lactate concentration, early volume intate, blood glucose changes, the length of ICU stay, 28-day hospital mortality, ICU mortality, in hospital mortality were recorded and compared with the control group.Results There were no differences in age, APACHEⅡand SOFA between two groups. Patients treated with the bundle therapy received more fluid within the first 6 hours(2 816.67±1 469.41 mL vs 1 882.22±1 024.63 mL, P=0.040〕. The CVP was significantly higher in the study group than that in the control group after the first 6 hours' treatment(11.2±4.74 mmHg vs 7.35±3.95 mmHg, P=0.018) and after 24 hours' treatment(10.53±2.67 mmHg vs 5.76±1.60 mmHg, P=0.000). The 28-day hospital mortality in the study group was significantly lower than that in the control group(33.7% vs 72.2%, P=0.038) . There were no significant differences in the first 3 day blood glucose between the two groups. There were no significant difference in ICU mortality and hospital mortality in the two groups.Conclusion Patients treated with early bundle therapy in the study group have given more active fluid resuscitation than those in the control group within the first 6 hours of septic shock, and 28-day hospital mortality in the study group is significantly decreased. Sepsis bundle may improve prognosis of patients with septic shock.

Key words: septic shock, early goal direct therapy, mortality