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：

膿毒性休克; 液體復蘇; 血乳酸清除率; 尿量

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【摘要】　目的　探討膿毒性休克早期液體復蘇的臨床反應性。　方法　對2008年2月—2010年2月38例采用早期目標定向治療方案治療的膿毒性休克患者按是否存活進行分組，就中心靜脈壓、心率、平均動脈壓、輸液量、尿量、血乳酸等指標進行評價。　結果　 38例采用早期目標定向治療方案治療6 h均達標，存活21例（55.26%），死亡17例（44.74%），兩組患者輸液總量及輸液種類差異無統計學意義（P gt;0.05），存活組6、24 h尿量及血乳酸清除率明顯優于死亡組（P lt;0.05）。　結論　血乳酸清除率及尿量可作為膿毒性休克液體復蘇有效的臨床監測指標。
【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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6.	徐向東, 吳健鋒, 管向東, 等. 早期乳酸清除率評估外科嚴重膿毒癥預后的臨床價值研究[J]. 中國實用外科雜志, 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.	張麗, 席修明, 姜利. 膿毒性休克患者的負液體平衡與預后的關系[J]. 首都醫科大學學報, 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.

1. 　強新華, 康焰. 膿毒血癥和感染性休克的治療現狀[J]. 華西醫學, 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. 　徐向東, 吳健鋒, 管向東, 等. 早期乳酸清除率評估外科嚴重膿毒癥預后的臨床價值研究[J]. 中國實用外科雜志, 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. 　張麗, 席修明, 姜利. 膿毒性休克患者的負液體平衡與預后的關系[J]. 首都醫科大學學報, 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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