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Intensive Care Med:严重感染和感染性休克:液体复苏模式与结局

2017-05-08 吴星 环球医学

严重感染和感染性休克最初几小时液体复苏的最佳模式存在争议,积极或保守均有推荐。2017年5月,发表在《Intensive Care Med》的一项研究调查了严重感染和感染性休克输液模式与结局。


严重感染感染性休克最初几小时液体复苏的最佳模式存在争议,积极或保守均有推荐。2017年5月,发表在《Intensive Care Med》的一项研究调查了严重感染和感染性休克输液模式与结局。

目的:严重感染和感染性休克最初几小时液体复苏的最佳模式存在争议,积极或保守均有推荐。

方法:研究者使用Premier医院2013出院数据库,分析 23513例从急诊室入住ICU,在入住ICU首日进行液体复苏的严重感染和感染性休克患者。第1天的输液分为1 L类,从1~1.99 L直至≥9 L,以考察第1天输液对患者死亡率的影响。使用患者年龄和住院时表现出的急性病症,研究者建立医院死亡和第1天接受大于5 L液体的二元应答模型。根据患者是否需要机械通气、是否有休克,对患者进行分组。使用加权线性回归,控制样本量和第1天输液类别的变化,研究者评价了低输液范围(第1天,1~5 L)和高输液范围(第1天,5~≥9 L)实际和预期死亡趋势的差异。

结果:第1天平均输液量4.4 L,在不需要机械通气和无休克组最低(3.6 L),在需要机械通气且有休克组最高(5.4 L)。第1天输液模式在医院规模、教学现状、农村/城市位置和国家区域方面高度一致。整个队列的在院死亡率为25.8%,入住ICU和住院平均时长分别为5.1和 9.1 天。在整个队列中,低容量复苏(1~4.99 L)与死亡率较小但显着的降低相关,为?0.7%每升(95% CI ?1.0%~?0.4%;p = 0.02)。但是,使用高容量复苏(5 ~≥9 L)的患者,每增加大于5 L的液体,死亡率增加2.3%(95% CI 2.0~2.5%;p = 0.0003)。每使用大于5 L的液体,总住院成本增加$999(校对R2 = 92.7%,p = 0.005)。

结论:美国严重感染和感染性休克患者在入住ICU的第一天输注的平均输液量低于脓毒症运动指南推荐。入住ICU的第一天输注大于5 L液体与死亡风险显着增加、住院成本显着升高相关。

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    2018-10-17 fenfei_100

    病重液体量大还是液体量大病情恶化,这需要分析。

    0

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    2017-06-08 1e145228m78(暂无匿称)

    学习了,谢谢作者分享!

    0

  5. 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    2017-05-19 惠映实验室

    输液的学习,剂量的调整

    0

  6. 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    2017-05-11 王秀

    学习了,谢谢分享!

    0

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href='/topic/show?id=c5c9211855f' target=_blank style='color:#2F92EE;'>#严重感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21185, encryptionId=c5c9211855f, topicName=严重感染)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智智灵药, createdTime=Wed May 10 11:47:00 CST 2017, time=2017-05-10, status=1, ipAttribution=)]
    2017-05-11 杨利洪

    学习了,提高了

    0

  8. 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    2017-05-10 lizhou0204
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