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[大学生论坛]:脓毒症的早期识别和治疗

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JoannaH 发表于 2018-1-2 14:31:16 | 显示全部楼层 |阅读模式
Background
In 2013, New York began requiring hospitals to follow protocols for the early identification and treatment of sepsis. However, there is controversy about whether more rapid treatment of sepsis improves outcomes in patients.
摘要
背景:2013年,纽约开始要求医院遵守早期识别和治疗脓毒症的协议。然而,人们对于脓毒症的快速治疗是否能改善患者的预后存在争议。
Methods
We studied data from patients with sepsis and septic shock that were reported to the New York State Department of Health from April 1, 2014, to June 30, 2016. Patients had a sepsis protocol initiated within 6 hours after arrival in the emergency department and had all items in a 3-hour bundle of care for patients with sepsis (i.e., blood cultures, broad-spectrum antibiotic agents, and lactate measurement) completed within 12 hours. Multilevel models were used to assess the associations between the time until completion of the 3-hour bundle and risk-adjusted mortality. We also examined the times to the administration of antibiotics and to the completion of an initial bolus of intravenous fluid. Results Among 49,331 patients at 149 hospitals, 40,696 (82.5%) had the 3-hour bundle completed within 3 hours. The median time to completion of the 3-hour bundle was 1.30 hours (interquartile range, 0.65 to 2.35), the median time to the administration of antibiotics was 0.95 hours (interquartile range, 0.35 to 1.95), and the median time to completion of the fluid bolus was 2.56 hours (interquartile range, 1.33 to 4.20). Among patients who had the 3-hour bundle completed within 12 hours, a longer time to the completion of the bundle was associated with higher risk-adjusted in-hospital mortality (odds ratio, 1.04 per hour; 95% confidence interval [CI], 1.02 to 1.05; P<0.001), as was a longer time to the administration of antibiotics (odds ratio, 1.04 per hour; 95% CI, 1.03 to 1.06; P<0.001) but not a longer time to the completion of a bolus of intravenous fluids (odds ratio, 1.01 per hour; 95% CI, 0.99 to 1.02; P=0.21).
方法:从2014年4月1日至2016年6月30日,纽约卫生部报告了脓毒症和感染性休克患者的资料。患者有脓毒症协议启动6小时内急救部门到达后,脓毒症有保健的一个小时把所有物品的患者(即,血培养,广谱抗菌剂,和乳酸测量)在12小时内完成。多层次的模型被用来评估之间的时间关系到3小时完成束和风险调整后的死亡率。我们还检查了时间给药的抗生素和完成初始静脉注射液。结果49331例患者在149家医院,40696(82.5%)在3小时内完成的3束。对3束完成的中位时间为1.30个小时(间距范围,0.65至2.35),要给予抗生素的中位时间为0.95个小时(四分位距为0.35到1.95),和流体的丸完成的平均时间为2.56小时(四分位距为1.33到4.20)。曾在12小时内完成的3束患者较长时间的束完成与较高的风险调整后的住院死亡率相关(比值比,每小时1.04;95%可信区间[CI],1.02到1.05;P<0.001),是一个较长时间的抗生素(比值比,每小时1.04;95% CI,1.03至1.06;P<0.001)而不是一个较长时间的大剂量静脉输液完毕(比值比,每小时1.01;95% CI,0.99到1.02;P = 0.21)。
Conclusions
More rapid completion of a 3-hour bundle of sepsis care and rapid administration of antibiotics, but not rapid completion of an initial bolus of intravenous fluids, were associated with lower risk-adjusted in-hospital mortality. (Funded by the National Institutes of Health and others.).
结论;更快速的完成一个抗生素脓毒症护理和快速管理3束,但不能快速完成静脉输液的初始剂量,都与较低的风险调整后的住院死亡率相关。(由美国国立卫生研究院和其他机构资助)。
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