早期限制性液体复苏策略在急诊脓毒症患者护理中的实践与效果评价:一项回顾性队列研究。

IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Jbi Evidence Implementation Pub Date : 2023-09-01 DOI:10.1097/XEB.0000000000000365
Xiaqing Hu, Jie Zhang, Peipei Wang, Xin Dai
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引用次数: 0

摘要

目的:探讨早期限制性液体复苏策略在急诊科脓毒症患者护理中的实践及效果评价。方法:选取2020年1 - 9月在我院急诊科就诊的脓毒症患者239例为研究对象,进行回顾性分析。根据液体复苏方法的不同分为改善组和对照组。改良组为限制性液体复苏112例;另外127例接受充分液体复苏的患者为对照组。观察两组患者ICU住院时间、呼吸机使用时间及28天死亡率。比较两组患者治疗前后血流动力学指标、急性生理与慢性健康评价(APACHE)ⅱ评分、序期器官衰竭评价(SOFA)评分及并发症发生情况。结果:治疗后,改良组患者APACHEⅱ评分和SOFA评分低于对照组,补液量减少,乳酸清除率提高,ICU住院时间缩短,呼吸机时间占ICU住院时间的比例降低。改善组急性呼吸窘迫综合征(ARDS)、cTn I、脑利钠肽发生率均显著低于对照组。从组内维度看,改善组和对照组治疗后APACHEⅱ评分、SOFA评分、心率和休克指数均低于治疗前。结论:限制性液体复苏可有效缓解急诊脓毒症患者病情,改善血流动力学,降低ARDS发生率,预防患者死亡。值得临床推广应用。
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Practice and effect evaluation of early restrictive fluid resuscitation strategy in the nursing care of patients with sepsis in the emergency department: a retrospective cohort study.

Objective: To explore the practice and effect evaluation of the early restrictive fluid resuscitation strategy in the nursing care of patients with sepsis in the emergency department.

Methods: A total of 239 sepsis patients, who were treated in the emergency department of our hospital from January to September 2020, were selected as the participants of this study, and a retrospective analysis was performed. According to different methods of fluid resuscitation, they were divided into an improved group and a control group. One hundred and twelve patients who received restrictive fluid resuscitation were in the improved group; another 127 patients who received adequate fluid resuscitation were in the control group. The ICU stay time, ventilator use time, and 28-day mortality rate of the two groups were observed. The hemodynamic indices, acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, and complications of the two groups before and after treatment were compared.

Results: After treatment, in the improved group, the APACHE II and SOFA scores were lower than in the control group, fluid replacement decreased, lactate clearance increased, ICU admission time shortened and the proportion of ventilator time to ICU admission time decreased. The incidence of acute respiratory distress syndrome (ARDS), cTn I and brain natriuretic peptic in the improved group were significantly lower than those in the control group. From the dimension within the group, the APACHE II score, SOFA score, heart rate and shock index were lower after treatment than before treatment in both the improved and control groups.

Conclusion: Restricted fluid resuscitation can effectively alleviate the condition of emergency sepsis patients, improve hemodynamics, reduce the incidence of ARDS, and prevent patient deaths. It is worthy of clinical application.

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CiteScore
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自引率
13.00%
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23
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