Anesth Analg:脓毒症干预治疗与住院期间患者死亡率的关系:真实世界数据回顾性分析

2019-06-30 佚名 罂粟花

脓毒症是对感染的全身反应,可导致组织损伤,器官衰竭和死亡。已经努力制定循证干预措施,以在疾病早期确定和控制脓毒症,以减少脓毒症相关的发病率和死亡率。我们用可靠的观察数据方法评估了微创脓毒症干预组与住院死亡率之间的关系。

背景与目的

脓毒症是对感染的全身反应,可导致组织损伤,器官衰竭和死亡。已经努力制定循证干预措施,以在疾病早期确定和控制脓毒症,以减少脓毒症相关的发病率和死亡率。我们用可靠的观察数据方法评估了微创脓毒症干预组与住院死亡率之间的关系。

方  法

我们对2012年1月1日至2014年12月31日期间在加州大学旧金山医学中心诊断为严重脓毒症/败血性休克(SS / SS)的成人出院患者进行了一项回顾性队列研究。脓毒症干预包括血乳酸测量;在开始使用抗生素前抽血培养;急诊科病人脓毒症发生3小时内使用广谱抗生素,住院病人1小时内使用;如果患者为低血压或乳酸盐水平> 4 mmol / L,则应用静脉补液;并且如果患者在输注液体后仍然低血压,则静脉应用血管加压剂。

结  果

整个干预依从性与死亡风险降低31%相关(调整后的发生率比率(IRR),0.69,95%置信区间[CI],0.53-0.91),根据急诊科病人SS / SS表现、入院时已经出现SS / SS( POA)、年龄、入院疾病严重程度和死亡风险、医疗补助/医疗保健支付者状态、免疫受损的宿主状态和充血性心力衰竭型POA来调整。调整后的需要治疗的人数(NNT)来挽救一个人的生命为15(CI,8-69)。与死亡率相关的其他独立因素包括入院时SS / SS (经调整的IRR,0.55; CI,0.32-0.92)和年龄增加(调整后的IRR,每10年增长1.13; CI,1.03-1.24)。

结  论

加利福尼亚大学旧金山分校的脓毒症病毒治疗与医院病房的住院死亡风险降低有关,因为混合因素和风险调整得到了强有力的控制。调整后的NNT提供了一个合理可行的目标,以评价诊断为SS / SS的患者预后改善的情况。

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    2019-10-31 AspirantSuo
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    2019-11-24 智慧医人
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