医护联合查房对脓毒性休克患者预后影响的临床研究

摘要

Objective To investigate the effects of union ward rounds by doctors and nurses on the prognosis of patients with septic shock during bundle treatment in the intensive care unit .Methods From Auguste 2013 to July 2014 ,55 patients with septic shock from ICU of Dazu People′s Hospital were randomly divided into two groups ,the control group(conventional bundle group ,27 patients) and the treatment group(union ward rounds by doctors and nurses group ,28 patients) .Time for achieving EGDT ,the scores on acute physiology and chronic health evaluation system Ⅱ(APACHE Ⅱ) before and after treatment ,cases using of vascu‐lar active drug ,lactate clearance rate ,the quantity of liquid ,mechanical ventilation time ,the time in intensive care unit (ICU) ,3 tube infection incidence ,28 mortality of two groups were observed .Results The time for achieving EGDT of treatment group was less than that in control group ,and 72 h after treatment in treatment group ,the APACHE Ⅱ score and application cases of vascular ac‐tive drugs were significantly lower than that of the control group (all P<0 .05) .The amount of recovery liquid in 6 h of the treat‐ment group was obviously more than that of the control group ,and liquid in 72 h was less than that of the control group (all P<0 .05) .Mechanical ventilation time and ICU stay time of the treatment group were less than that of the control group (all P<0 . 05) ,but there were no significant difference in 3 tube infection incidence ,28 mortality of two groups (all P>0 .05) .Conclusion For the patients with septic shock in the intensive medicine treatment ,application of union ward rounds by doctors and nurses can improve the quality of compliance and nursing ,so as to shorten the time for EGDT ,mechanical ventilation time ,ICU stay time and reduce the average hospitalization expenses .%目的：探讨医护联合查房对在重症医学科集束化治疗期间的脓毒性休克（S S ）患者的预后及影响。方法选择2013年8月至2014年7月大足区人民医院重症医学科收治的55例SS患者，按随机数字表法分为对照组（常规集束化，27例）和治疗组（医护联合查房集束化，28例）。观察两组患者早期目标导向治疗（EGD T ）达标时间、治疗前后急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分和使用血管活性药物的例数、乳酸清除率、复苏液体量的变化及机械通气时间、入住ICU时间、三管感染发生率、住院28 d病死率。结果治疗组达到EGDT达标时间明显早于对照组，且治疗72 h后治疗组APACHEⅡ评分及运用血管活性药物的例数显著低于对照组（均 P＜0．05）；治疗组6、12 h乳酸清除率均明显高于对照组（均 P＜0．05）；治疗组6 h内使用复苏液体量明显多于对照组，而72 h复苏液体量较对照组少（均 P＜0．05）。治疗组机械通气时间、入住IC U时间也较对照组明显缩短（均 P＜0．05），但两组三管感染率及住院28 d病死率差异无统计学意义（均 P＞0．05）。结论医护联合查房能提高护士的依从性及护理质量，从而缩短SS患者在重症医学科治疗期间的EGDT达标时间、机械通气时间、ICU住院时间及降低患者平均住院费用。