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目的探讨早期目标指导治疗(EGDT)治疗外科严重脓毒症临床价值。方法将2004年8月至2007年6月收治于浙江省7家三甲医院ICU的177例外科严重脓毒症病人随机分为常规组(n=90)和EGDT组(n=87)。前者以中心静脉压(CVP)、平均动脉压(MAP)或收缩压(SBP)、尿量(UO)变化指导液体复苏,后者在此基础上增加中心静脉血氧饱和度(ScvO2)为观测指标进行复苏;入选后,对病人行输液、输血和强心等治疗,6h内达标;比较两组病人28d存活率(主要终点)、ICU住院时间、机械通气时间、抗生素使用时间、合并新感染情况和临床评分(次要终点)的差异。结果EGDT组28d存活率较常规组增高约18%(79.3%vs61.1%,P=0.023),EGDT明显改善APACHEII评分(21.7±5.9vs15.4±4.3,P=0.008)和MODS评分(8.4±3.3vs5.1±2.9,P=0.017),EGDT对其他次级终点均无显著影响(均P>0.05)。结论EGDT可以显著改善外科脓毒症病人28d存活率和临床评分,对病人预后有益。
Objective To investigate the clinical value of early target therapy (EGDT) in the treatment of severe surgical sepsis. Methods A total of 177 surgical severe sepsis patients admitted to ICU of 7 top three hospitals in Zhejiang province from August 2004 to June 2007 were randomly divided into routine group (n = 90) and EGDT group (n = 87). The former instructed liquid resuscitation on the basis of CVP, MAP or SBP and urine volume (UO), and the latter was based on the observation that the increase of central venous oxygen saturation (ScvO2) The patients were enrolled in this study. Intravenous infusion, blood transfusion and cardiotocography were given to patients within 6 hours. The 28-day survival rate (main endpoint), ICU hospitalization time, mechanical ventilation time, antibiotic use time and new infection were compared Differences in condition and clinical score (secondary end point). Results The survival rate of EGDT group at 28d was increased by 18% (79.3% vs 61.1%, P = 0.023) compared with that of the conventional group. The EGDT significantly improved APACHEII score (21.7 ± 5.9 vs 15.4 ± 4.3, P = 0.008) ± 3.3 vs 5.1 ± 2.9, P = 0.017), while EGDT had no significant effect on other secondary end points (all P> 0.05). Conclusion EGDT can significantly improve the survival rate and clinical score of patients with surgical sepsis 28d, which is beneficial to the prognosis of patients.