严重脓毒血症和脓毒性休克早期目标化治疗在中国大陆部分医院急诊科实施现状调查

摘要

目的 了解早期目标化治疗(early goal-directed therapy,EGDT)在中国内地医院急诊科实施情况,分析存在的问题.方法 采取问卷方式,调查26个省市、56家医院急诊科的516名医生对EGDT的知晓率、实施率及不能实施的原因.结果 三甲医院的医生88.7%知道严重脓毒血症和脓毒性休克的诊断标准、91.6%知道有相关指南和74.2%知道早期目标化治疗的具体内容;而二甲医院的医生则分别只有30.2%、34.1%和25.6%;三乙医院分别为68.3%,77.3%和43.9%.不同级别医生知晓率差异有统计学意义(P＜0.05).三甲医院EGDT完全实施率13.3%,二甲医院没有能完全实施,其急诊医生认为,EGDT不能完全实施最主要的原因是患者经济条件(60.9%),其次是医生个人认知水平及临床操作技能(53.1%).但即使是在完全了解EGDT的具体内容和主导思想以后,也仅有31.0%的医生愿意在实际工作中去完全实施,有7.0%仍坚持完全不实施.结论 中国急诊医生中对EGDT知晓率及实施意愿都较低,是影响其实施的重要原因;其他影响因素还包括:患者经济条件和依从性差、缺乏推广实施的制度与相关专业团队的建设、医生不愿承担过多的医疗风险以及对EGDT有效性的认可度低.%Objective To ask for the information of status survey of early goal - directed therapy (EGDT) implemented for severe sepsis and septic shock patients in emergency department of hospital in China Mainland. Methods Questionnaire survey was used to ask for the information of witting rate, implementation rate and the causes of impracticability for EGDT in 516 emergency medicine specialists of 56 hospitals in 26 provinces and cities. Results There were significant difference in witting rates among emergency medicine specialists of different class hospitals(P ＜ 0.05). 88.7％ of emergency medicine specialists in Third - A class hospital had some knowledge of diagnostic criteria of severe sepsis and septic shock, 91.6％ learned the name about" international guidelines for management of severe sepsis and septic shock"and 72.4％ knew the EGDT; the witting rates were 30. 2％ , 34.1％ and 25.6％ respectively in Second - A class hospital; 68.3％, 77.3％ and 43.9％ respectively in Third - B class hospital. Complete implementation rate of EGDT in Third - A class hospital was 13.3％, but EGDT could not be implemented adequately in all of Second - A class hospital. Emergency medicine specialists thought that the first cause of EGDT could not be implemented was weak economic condition of patients, the second cause was the knowledge and clinic skill of physician (60. 9％ and 53. 1％ respectively). Even though completely known the content of EGDT, only 31.0％ of emergency medicine specialists would like to implement it, and 7.0％ refused to do it. Conclusion The main influencing factors of EGDT are the low witting rate and implementation desire in emergency medicine specialists in China Mainland. The other causes include weak economic conditions and the obedience of patients; lack of the rules for EGDT popularization and implementation, professional team establishment; low acceptance for EGDT effectiveness in emergency medicine specialists.