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摘要：
目的 探究3 h内完成初始30 ml/kg液体复苏量对脓毒症休克患者炎症因子及预后的影响。 方法 回顾性分析108例脓毒症休克患者临床资料，根据30 ml/kg液体复苏量完成时间是否≤3 h分为达标组（≤3 h，52例）和未达标组（>3 h，56例）。比较两组患者复苏前一般资料、序贯器官衰竭（Sequential Organ Failure Assessment, SOFA）评分和急性生理学和慢性健康状况评估Ⅱ（Acute Physiology and Chronic Health Evaluation Ⅱ, APACHEⅡ）评分、乳酸（lactic acid, Lac）、氧合指数（oxygenation index，OI）；比较两组患者炎症因子水平，包括复苏前C反应蛋白（C‐reactive protein, CRP）、降钙素原（procalcitonin, PCT）以及复苏第3天的CRP、PCT、IL‐6、TNF‐α、IL‐10；比较两组患者28 d内存活且不需要机械通气时间、28 d内存活且不需要肾脏替代治疗时间、28 d内存活且非ICU住院时间、总住院时间、28 d病死率；根据28 d生存情况构建两组患者28 d生存率的Kaplan‐Meier曲线，进行生存分析。 结果 复苏前CRP、PCT两组间差异无统计学意义（P>0.05）；两组患者复苏第3天CRP、PCT水平均较复苏前下降（P<0.05）；复苏第3天达标组CRP、PCT、IL‐6、TNF‐α水平较未达标组低（P<0.05)，而两组患者IL‐10水平差异无统计学意义（P>0.05)。达标组28 d内存活且不需要机械通气时间、28 d内存活且不需要肾脏替代治疗时间、28 d内存活且非ICU住院时间较未达标组更长（P<0.05）。两组患者总住院时间差异无统计学意义（P>0.05）。达标组28 d病死率低于未达标组（P<0.001）。Kaplan‐Meier生存分析结果显示，达标组的28 d生存率高于未达标组（log‐rank 检验，P<0.001）。 结论 3 h内完成初始30 ml/kg液体复苏量有利于降低脓毒症休克患者炎症反应，并与较低的28 d病死率相关。
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Abstract: Objective To investigate the effect of completion of initial 30 ml/kg fluid resuscitation within 3 h on inflammatory factors and prognosis in patients with septic shock. Methods A total of 108 patients with septic shock were selected and their clinical data were retrospectively analyzed. According to the time of 30 ml/kg fluid resuscitation (completion within 3 h or not), the patients were divided into two groups: a standard group (n=52) and a sub‐standard group (n=56). Both groups were compared for general information, Sequential Organ Failure Assessment (SOFA) sores, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) scores, lactic acid (Lac), and oxygenation index (OI). Furthermore, the levels of C‐reactive protein (CRP), procalcitonin (PCT), interleukin (IL)‐6, tumor necrosis factor (TNF)‐α and IL‐10 were recorded. Both groups were also compared for the time of 28‐day survival without mechanical ventilation, the time of 28‐day survival without renal replacement therapy, the time of 28‐day survival without intensive care unit (ICU) stay, the total length of hospitalization, and 28‐day mortality. The Kaplan‐Meier curves were plotted to estimate the probability of 28‐day cumulative survival in the two groups. Results There were no statistical differences in CRP and PCT between the two groups before resuscitation (P>0.05). Compared with before resuscitation, the two groups showed lower levels of CRP and PCT at post‐resuscitation day 3 (P<0.05）. At post‐resuscitation day 3, the standard group showed lower levels of CRP, PCT, IL‐6 and TNF‐α than the sub‐standard group (P<0.05), without statistical difference in IL‐10 levels between the two groups (P>0.05). Furthermore, the standard group showed increases in the time of 28‐day survival without mechanical ventilation, the time of 28‐day survival without renal replacement therapy, the time of 28‐day survival without ICU stay (P<0.05). There were no statistical differences in the total length of hospitalization stay between the two groups (P> 0.05). The 28‐day mortality in the standard group was lower than that in the sub‐standard group (P<0.001). The Kaplan‐Meier survival analysis showed that the probability of 28‐day cumulative survival in the standard group was higher than that in the sub‐standard group (log‐rank test, P<0.001). Conclusions Completion of initial 30 ml/kg fluid resuscitation within 3 h can reduce inflammation in patients with septic shock, and is associated with the 28‐day mortality.
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