目的 探讨不同液体管理对脓毒性休克患者死亡风险的影响。方法 收集119例脓毒性休克患者的基本资料、SOFA评分及每日出入量。按患者补液量分组,分析脓毒性休克患者液体量与生存的关系。结果 死亡组休克发生后前2 d平衡补液量明显高于生存组(P=0.031)。在按2 d补液累积量作四分位数分组的生存分析中,液体累积平衡量最高组生存率明显低于液体累积平衡量最低组(P=0.037),其余组间无差异。休克2 d后高SOFA评分组(>5分)的死亡风险是低SOFA评分组(<5分)的1.322倍, 2 d累计补液量最高组的死亡风险增高2.957倍。结论 脓毒性休克患者早期补液量多少与预后有明显相关性,2 d累计补液量多的患者预后差。脓毒性休克患者SOFA评分能较好反应患者的病情严重程度。
Objective To investigate the effects of different early fluid management approaches on the death risk of patients with septic shock.Methods Basic information, SOFA score, and daily intake and output volume of 119 patients with septic shock were collected. Correlation between liquid volume and outcome of patients with septic shock was analysed based on the liquid intake and output volume.Results The daily fluid balance in the first two days of the dead group was significantly higher than that of the survival group (P=0.031). The survival rate was significantly lower in the patients in the third quartile of 2-day cumulative fluid balance versus those in the first quartile (P=0.037). After 2 days of shock, the death risk in the high SOFA score group (>5 points) was higher than that in the low SOFA score group (<5 points) (P<0.001). The death risk was increased to 2.957 times in the patients in the third quartile of 2-day cumulative fluid balance (P=0.012).Conclusion The septic shock patients’ prognosis is related to the volume of early fluid input. The patients with a large volume of fluid intake showed poor prognosis. The SOFA score can reflect the severity of septic shock patients.
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