Clinical Evaluation of the Response of Patients with Septic Shock to Early Fluid Resuscitation_West China Medical Journal

Authors：

YANG Mingquan , CAO Jianwei , CHEN Yanmei

Intensive Care Unit, the First People’s Hospital of Zigong, Zigong, Sichuan 643000, P. R. China;

Corresponding author：

Keywords：

脓毒性休克; 液体复苏; 血乳酸清除率; 尿量

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【摘要】　目的　探讨脓毒性休克早期液体复苏的临床反应性。　方法　对2008年2月—2010年2月38例采用早期目标定向治疗方案治疗的脓毒性休克患者按是否存活进行分组，就中心静脉压、心率、平均动脉压、输液量、尿量、血乳酸等指标进行评价。　结果　 38例采用早期目标定向治疗方案治疗6 h均达标，存活21例（55.26%），死亡17例（44.74%），两组患者输液总量及输液种类差异无统计学意义（P gt;0.05），存活组6、24 h尿量及血乳酸清除率明显优于死亡组（P lt;0.05）。　结论　血乳酸清除率及尿量可作为脓毒性休克液体复苏有效的临床监测指标。
【Abstract】　Objective　 To study the clinical response to early fluid resuscitation therapy in septic shock patients.　Methods　 Thirty-eight septic shock patients received early goal-directed therapy (EGDT) in the ICU of our hospital from February 2008 to February 2010. The patients were divided into survival group (n=21) and dead group (n=17). Indexes like central venous pressure (CVP), heart rate (HR), mean arterial pressure (MAP), fluid input, urine output, and blood lactate were evaluated.　Results　 Six hours after the EGDT, the results for the patients were all up to standard. There were 21 cases of survival (55.26%) and 17 cases of death (44.74%). The total fluid input and liquid types were similar in the two groups (P gt;0.05). The urine output and lactate clearance at hour 6 and 24 for the survival group were better than that for the dead group (P lt;0.05).　Conclusion　 The lactate clearance and urine output can be regarded as an surveillance indicator of fluid resuscitation for patients with septic shock.

Citation： YANG Mingquan,CAO Jianwei,CHEN Yanmei. Clinical Evaluation of the Response of Patients with Septic Shock to Early Fluid Resuscitation. West China Medical Journal, 2011, 26(6): 863-866. doi: Copy

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12.	张丽, 席修明, 姜利. 脓毒性休克患者的负液体平衡与预后的关系[J]. 首都医科大学学报, 2007, 28(5): 562-565.
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1. 　强新华, 康焰. 脓毒血症和感染性休克的治疗现状[J]. 华西医学, 2005, 20(4): 791-792.
2. 　American Colege of Chest Physiciana/Society of Critical Care Medicine Consensus Confeernce.Definitionsforse psisa ndorgan failure and guidelines for the use of innovative therapies in sepsis [J].Crit Care Med, 1992, 20(6): 864-874.
3. 　Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008[J]. Crit Care Med, 2008, 36(1): 296-327.
4. 　Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock[J]. N Engl J Med, 2001, 345(19): 1368 -1377.
5. 　Lee SW, Hong YS, Park DW, et al. Lactic acidosis not hyperlactatemia as a predictor of inhospital mortality in septic emergency patients[J]. Emergency Medicine J, 2008, 25(10): 659-665.
6. 　徐向东, 吴健锋, 管向东, 等. 早期乳酸清除率评估外科严重脓毒症预后的临床价值研究[J]. 中国实用外科杂志, 2007, 27(12): 969-970.
7. 　Nguyen HB, Rivers EP, Knoblicb BP, et al. Earlylactate clearanceis associated with improved outcome in severe sepsis and septic shock[J]. Crit Care Med, 2004, 32(8): 1785-1786.
8. 　Sablotzki A, Muhling J, Czeslick E. Sepsis and multiple organ failure-update of current therapeutic concepts[J]. Anasthesiol Intensivmed Notfallmed Sehmerzthe, 2005, 40(9): 511-520.
9. 　Dellinger RP. Cardiovascular management of septic shock[J]. Crit Care Med, 2003, 31(3): 946-955.
10. 　Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit[J]. N Engl J Med, 2004, 350(22): 2247-2256.
11. 　Alsous F, Khamices M, DeGirolamo A, et al. Negative fluid balance predicts surgival in patients with septic shock:a retrospective pilot study[J]. Chest, 2000, 117(6): 1749-1754.
12. 　张丽, 席修明, 姜利. 脓毒性休克患者的负液体平衡与预后的关系[J]. 首都医科大学学报, 2007, 28(5): 562-565.
13. 　Flierl MA, Rittirsch D, Hube-Lang MS, et al. Molecular events in the cardiomyopathy of sepsis[J]. Mol Med, 2008, 14(5-6): 327-336.

West China Medical Journal

Clinical Evaluation of the Response of Patients with Septic Shock to Early Fluid Resuscitation

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