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目的探讨脓毒症合并低灌注患者早期充分复苏对后续治疗效果的影响。方法2004年6月至2005年12月,我院外科和呼吸重症加强治疗病房连续收治的脓毒症合并低灌注患者共34例,进行及时充分复苏治疗。根据复苏达标时间是否超过12 h将患者分为早期复苏组(15例)和晚期复苏组(19例),并比较两组患者对后续治疗的反应和脏器功能影响。结果早期充分复苏后,晚期复苏组需再次复苏治疗的占73．7％,早期复苏组为20．0％(P<0．01);晚期复苏组需激素替代治疗者为63．2％,凝血功能障碍和多器官功能障碍综合征的发生率分别为73．7％和68．4％,均显著高于早期复苏组(P<0．05)。复苏后第7天,早期复苏组血肌酐显著低于晚期复苏组(P<0．05);复苏后,早期复苏组各时点心率均显著低于晚期复苏组(P<0．05);复苏7天后,早期复苏组氧分压和氧合指数均显著高于晚期复苏组(P<0．05)。晚期复苏组院内病死率为42．1％,早期复苏组13．3％(P<0．05)。结论早期充分复苏治疗可明显增强脓毒症患者对后续治疗的敏感性,并减轻炎症和凝血反应对重要脏器的损害,从而降低其病死率。
Objective To investigate the effect of early full recovery of sepsis patients with hypoperfusion on follow-up treatment. Methods From June 2004 to December 2005, a total of 34 patients with sepsis and hypoperfusion admitted with surgical and respiratory intensive care unit in our hospital were enrolled in this study. The patients were divided into early resuscitation group (n = 15) and late resuscitation group (n = 19) according to whether the resuscitation time exceeded 12 h, and the response to follow-up and organ function were compared between the two groups. Results In the early resuscitation group, 73.7% were needed for resuscitation, 20.0% in early resuscitation group (P <0.01), 63.2% in hormone replacement regimen in late resuscitation group, The incidences of coagulopathy and multiple organ dysfunction syndrome were 73.7% and 68.4%, respectively, which were significantly higher than those in the early resuscitation group (P <0.05). On the 7th day after resuscitation, the serum creatinine in the early resuscitation group was significantly lower than that in the late resuscitation group (P <0.05). After resuscitation, the heart rate of the early resuscitation group was significantly lower than that of the late resuscitation group (P <0.05). After 7 days of resuscitation, the oxygen partial pressure and oxygenation index in the early resuscitation group were significantly higher than those in the late resuscitation group (P <0.05). The hospital mortality rate was 42.1% in the advanced resuscitation group and 13.3% in the early resuscitation group (P <0.05). Conclusion Early full recovery treatment can significantly enhance the sensitivity of patients with sepsis to follow-up treatment, and reduce inflammation and clotting damage to important organs, thereby reducing its mortality.