抗感染督导治疗对脓毒症患者预后影响的研究(1)
摘要：目的 觀察督导抗感染治疗策略对脓毒症患者预后的影响，为临床提供实用、安全、有效的综合抗感染治疗指导。方法 收集2016年4月～2017年1月在我院呼吸内科住院的脓毒症患者50例，根据随机数字表法分为督导治疗组26例和对照组24例。对照组的患者进行常规治疗，督导治疗组患者接受抗感染方案的监督指导。在患者的病程中记录抗感染治疗后患者的症状变化及抗感染疗效评价，比较两组患者的细菌清除率，抗感染效果评价，7 d及14 d死亡率;入院后第1，2，3，7，14天心肌酶及心肌标志物、血尿素氮及肌酐、凝血功能;入院7 d的液体入量、平均动脉压、降钙素原。结果 两组患者在平均住院时间、平均医疗费用、细菌/真菌检出率，抗生素使用时间、抗菌药物使用强度、7 d及14 d死亡率比较，差异无统计学意义(P>0.05)。督导治疗组细菌清除率及抗感染有效率均优于对照组(P<0.05)。督导治疗组患者感染部位依次为肺部73.07%，胆道15.38%，余泌尿系、皮肤、血液占11.55%。最主要的感染部位均为肺部，分别占73.07%及50.00%;细菌培养结果前三位依次铜绿假单胞菌，鲍曼不动杆菌，肺炎克雷伯菌。入院后第1，2，3，7，14天心肌酶、心肌标志物、血尿素氮及肌酐、凝血功能分别比较，差异均无统计学意义(P>0.05)，但督导治疗组恢复较对照组更平稳迅速。两组患者第1，2，3，7天的SOFA评分及7 d液体入量比较，差异无统计学意义(P>0.05)。两组患者入院治疗24 h后降钙素原比较，差异有统计学意义(P<0.05)，督导治疗组下降更明显。结论 抗感染督导治疗可以有效提高脓毒症患者的细菌清除率及抗感染效果，且患者器官功能恢复更快。
, 百拇医药
关键词：抗感染督导治疗;脓毒症;细菌清除率
中图分类号：R459.7 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.01.026
文章编号：1006-1959(2019)01-0082-06
Study on the Effect of Anti-infective Supervision on the Prognosis of Patients with Sepsis
SHEN Gui，PENG Xiang，QIN Guang-mei
(Department of Respiratory Medicine，Yongchuan Hospital，Chongqing Medical University，Chongqing 402160，China)
, 百拇医药
Abstract：Objective To observe the effect of supervising anti-infective treatment strategy on the prognosis of patients with sepsis， and provide practical， safe and effective comprehensive anti-infective treatment guidance for the clinic. Methods A total of 50 patients with sepsis admitted to our Department of Respiratory Medicine from April 2016 to January 2017 were enrolled. According to the random number table， 26 patients were in the supervision group and 24 patients in the control group. Patients in the control group underwent routine treatment， and patients in the treatment group were supervised and guided by the anti-infective program. In the course of the patient's disease， the patients' symptoms and anti-infective effects were evaluated. The bacterial clearance rate and anti-infective effect were compared between the two groups. The mortality rate was 7 d and 14 d. Myocardial enzymes and myocardial markers， blood urea nitrogen and creatinine， coagulation function on the 1st， 2nd， 3rd， 7th， and 14th d after admission; liquid intake， mean arterial pressure， and procalcitonin at 7 d after admission. Results There were no significant differences in the average length of hospital stay， average medical cost， bacterial/fungus detection rate， antibiotic use time， antibacterial use intensity， and 7 d and 14 d mortality between the two groups (P>0.05). The bacterial clearance rate and anti-infection efficiency of the supervised treatment group were better than those of the control group (P<0.05). In the treatment group， the infection site was 73.07% in the lungs， 15.38% in the biliary tract， and 11.55% in the abdomen， skin and blood. The most important infection sites were lungs， accounting for 73.07% and 50.00%， respectively. The top three bacterial cultures were Pseudomonas aeruginosa， Acinetobacter baumannii and Klebsiella pneumoniae. There were no significant differences in myocardial enzymes， myocardial markers， blood urea nitrogen， creatinine and coagulation between the 1st， 2nd， 3rd， 7th and 14th d after admission (P>0.05)， but the control group recovered compared with the control group is more stable and fast. There was no significant difference in SOFA scores and 7 d fluid intake between the two groups on days 1， 2， 3， and 7 (P>0.05). There was a statistically significant difference between the two groups of patients after 24 h of admission to procalcitonin (P<0.05). The decrease in the treatment group was more obvious. Conclusion Anti-infective supervision can effectively improve the bacterial clearance rate and anti-infection effect of patients with sepsis， and the organ function recovery is faster., 百拇医药(申贵 彭翔 秦光梅)
, 百拇医药
关键词：抗感染督导治疗;脓毒症;细菌清除率
中图分类号：R459.7 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.01.026
文章编号：1006-1959(2019)01-0082-06
Study on the Effect of Anti-infective Supervision on the Prognosis of Patients with Sepsis
SHEN Gui，PENG Xiang，QIN Guang-mei
(Department of Respiratory Medicine，Yongchuan Hospital，Chongqing Medical University，Chongqing 402160，China)
, 百拇医药
Abstract：Objective To observe the effect of supervising anti-infective treatment strategy on the prognosis of patients with sepsis， and provide practical， safe and effective comprehensive anti-infective treatment guidance for the clinic. Methods A total of 50 patients with sepsis admitted to our Department of Respiratory Medicine from April 2016 to January 2017 were enrolled. According to the random number table， 26 patients were in the supervision group and 24 patients in the control group. Patients in the control group underwent routine treatment， and patients in the treatment group were supervised and guided by the anti-infective program. In the course of the patient's disease， the patients' symptoms and anti-infective effects were evaluated. The bacterial clearance rate and anti-infective effect were compared between the two groups. The mortality rate was 7 d and 14 d. Myocardial enzymes and myocardial markers， blood urea nitrogen and creatinine， coagulation function on the 1st， 2nd， 3rd， 7th， and 14th d after admission; liquid intake， mean arterial pressure， and procalcitonin at 7 d after admission. Results There were no significant differences in the average length of hospital stay， average medical cost， bacterial/fungus detection rate， antibiotic use time， antibacterial use intensity， and 7 d and 14 d mortality between the two groups (P>0.05). The bacterial clearance rate and anti-infection efficiency of the supervised treatment group were better than those of the control group (P<0.05). In the treatment group， the infection site was 73.07% in the lungs， 15.38% in the biliary tract， and 11.55% in the abdomen， skin and blood. The most important infection sites were lungs， accounting for 73.07% and 50.00%， respectively. The top three bacterial cultures were Pseudomonas aeruginosa， Acinetobacter baumannii and Klebsiella pneumoniae. There were no significant differences in myocardial enzymes， myocardial markers， blood urea nitrogen， creatinine and coagulation between the 1st， 2nd， 3rd， 7th and 14th d after admission (P>0.05)， but the control group recovered compared with the control group is more stable and fast. There was no significant difference in SOFA scores and 7 d fluid intake between the two groups on days 1， 2， 3， and 7 (P>0.05). There was a statistically significant difference between the two groups of patients after 24 h of admission to procalcitonin (P<0.05). The decrease in the treatment group was more obvious. Conclusion Anti-infective supervision can effectively improve the bacterial clearance rate and anti-infection effect of patients with sepsis， and the organ function recovery is faster., 百拇医药(申贵 彭翔 秦光梅)