液体复苏对于严重脓毒症患者生存率的预后分析

目的:严重脓毒症中液体复苏的生理病理学理论支持及动物实验证据不足,有必要进行相关临床试验来确定液体复苏对于严重脓毒症患者预后的影响。方法:将26名严重脓毒症和脓毒症休克患者分为液体复苏组和非液体复苏组。比较两组的28天生存率,ICU住院天数的差别,对两组在院生存天数进行生存函数分析。结果:液体复苏组的28天生存率为41.7%,未液体复苏组的28天生存率为50.0%,之间没有统计学差异(P=0.713)。液体复苏组的平均住院天数为24.7±6.0天,未液体复苏组的平均住院天数为17.7±3.4天,两组之间没有统计学差异(P=0.308)。液体复苏组的中位在院生存天数为38.0[28.0,48.0],液体复苏组的中位在院生存天数为25.0[22.8,27.2]。两组之间有显著统计学差异,(Log Rank P=0.044,Breslow P=0.025)。结论:在严重脓毒症及脓毒症休克患者中,采取液体复苏能够延长患者的中位在院生存天数,可见液体复苏在严重脓毒症的治疗中有重要意义。尚未发现液体复苏能提高严重脓毒症患者28天生存率的相关证据。采取液体复苏究竟能否改善严重脓毒症患者预后,还需要大样本随机临床对照试验来证明。

The Impact of Fluid Resuscitation on the Prognosis of Severe Sepsis

Objective:Since that fluid resuscitation in severe sepsis has weak physiology support and limited experimentalsupport, this clinical trial is performed to verify the hypothesis that fluid resuscitation may not necessarily increase 28-day rate of survivalfor severe sepsis patients.Methods:A prospective 12-month cohort study in intensive care units was conducted in the second hospitalaffiliated to the second military university to assess the prognosis of severe sepsis patients. According to whether fluid resuscitation wastaken, included patients were divided into fluid-resuscitation group and non-fluid-resuscitation group. 28-day survival rate and length ofintensive care unit stay were major measure standards to examine the survival difference between two groups. And continuous survivalfunction was also analyzed between two groups.Results:In the year 2012, among the 26 included cases of severe sepsis, there were 12cases of fluid resuscitation and 14 cases without fluid resuscitation. The 28-day survival rate of fluid-resuscitation group is near that ofnon-fluid-resuscitation group (41.7% vs 50.0%, P=0.713). There were no statistical differences in the length of intensive care unit staybetween the two groups (24.7± 6.0 vs 17.7± 3.4, P=0.308). The median days of survival of fluid-resuscitation group were 38.0[28.0,48.0] (median, [95%Cl] ) versus that of non-fluid-resuscitation group 25.0[22.8, 27.2], with statistical differences (Log Rank P=0.044,Breslow P=0.025).Conclusion:For severe sepsis and septic shock patients, fluid resuscitation prolongs the length of survival in hospitalwith statistical significance, which supports the therapeutic role of fluid resuscitation in severe sepsis. However, evidence that fluidresuscitation improve the 28-day survival rate has not been found. Therefore, large-sample randomized clinical trials are needed to verifythe influence of fluid resuscitation on the prognosis of severe sepsis and septic shock patients.