乳酸清除率对脓毒性休克早期液体复苏治疗的影响
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摘要
目的观察乳酸清除率对脓毒性休克早期液体复苏治疗的影响。方法 70例脓毒性休克患者随机分成EGDT组(EGDT组)和乳酸清除率指导EGDT组(L-EGDT组),每组各35例。分别记录各组的年龄、性别、体重、入院SOFA评分,以及补液量、每小时尿量和7 d,28 d的病死率。结果两组患者的年龄、性别、体重、入院SOFA评分以及补液量、第1小时尿量无显著差异(P>0.05)。L-EGDT组6 h总尿量大于EGDT组(P<0.05),L-EGDT组7 d和28 d病死率小于EGDT组(P<0.05)。结论乳酸清除率指导的早期液体复苏治疗能降低脓毒性休克患者病死率。
Objective To estimate the efficacies of early fluid resuscitation as guided by lactic acid clearance rate in patients with septic shock. Methods 70 patients diagnosed as septic shock were randomly divided into EGDT group and lactic acid clearance rate guided EGDT group( L-EGDT). Each group included 35 patients. Recorded age,gender,weight,score of SOFA,the amount of fluid for resuscitation,per hour urine output,the 7-day mortality and the 28-day mortality of patients in different groups. Results No significant difference existed in age,gender,weight,and score of SOFA. There was no significant difference of the amount of fluid for resuscitation and the 1 st-hour urine volume( P> 0.05). Compared with group EGDT,the 6-hour accumulative urine volume of group L-EGDT was significantly increased( P<0.05). Compared with group EGDT,7-day and28-day mortality of the group L-EGDT was significantly decreased( P < 0. 05). Conclusions Early fluid resuscitation guided by lactic clearance rate could lower mortality in patients with septic shock.
Objective To estimate the efficacies of early fluid resuscitation as guided by lactic acid clearance rate in patients with septic shock. Methods 70 patients diagnosed as septic shock were randomly divided into EGDT group and lactic acid clearance rate guided EGDT group( L-EGDT). Each group included 35 patients. Recorded age,gender,weight,score of SOFA,the amount of fluid for resuscitation,per hour urine output,the 7-day mortality and the 28-day mortality of patients in different groups. Results No significant difference existed in age,gender,weight,and score of SOFA. There was no significant difference of the amount of fluid for resuscitation and the 1 st-hour urine volume( P> 0.05). Compared with group EGDT,the 6-hour accumulative urine volume of group L-EGDT was significantly increased( P<0.05). Compared with group EGDT,7-day and28-day mortality of the group L-EGDT was significantly decreased( P < 0. 05). Conclusions Early fluid resuscitation guided by lactic clearance rate could lower mortality in patients with septic shock.
引文
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[2] Shankar-Hari M,Phillips GS,Levy ML,et al. Developing a new definition and assessing new clinical criteria for septic shock:for the third international consensus definitions for sepsis and septic shock(Sepsis-3)[J].JAMA,2016,315(8):775-787.
[3] Rivers E,Nguyen B,Havstad S,et al.Early goal-directed therapy in the treatment of severe sepsis and septic shock[J]. N Engl J Med,2001,345(19):1368-1377.
[4] Mouncey PR, Osborn TM, Power GS, et al. Protocolised management in sepsis(proMISe):a multicentre randomised controlled trial of the clinical effectiveness and cost-effectiveness of early,goal-directed,protocolised resuscitation for emerging septic shock[J].Health Technol Assess,2015,19(97):1-150.
[5] Boyd JH,Forbes J,Nakada TA,et al.Fluid resuscitation in septic shock:a positive fluid balance and elevated central venous pressure are associated with increased mortality[J].Crit Care Med,2011,39(2):259-265.
[6] Arnold RC,Shapiro NI,Jones AE,et al.Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis[J].Shock,2009,(1):35-39.
[7] van Zanten AR,Brinkman S,Arbous MS,et al.Guideline bundles adherence and mortality in severe sepsis and septic shock[J].Crit Care Med,2014,42(8):1890-1898.
[8]常莉,董云.早期目标导向治疗改善脓毒性休克患者的预后[J].中华危重病急救医学,2015,27(11):899-905.
[9] Textoris J,Fouche L,Wiramus S,et al.High central venous oxygen saturation in the latter stages of septic shock is associated with increased mortality[J].Crit Care Med,2011,15(4):R176-R176.
[10] Nguyen HB,Rivers EP,Knoblich BP,et al.Early lactate clearance is associated with improved outcome in severe sepsis and septic shock[J].Crit Care Med,2004,32:1637-1642.