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目的:研究集束化治疗对综合ICU严重脓毒症患者循环灌注和乳酸清除率的影响。方法:将2007年10月至2009年12月我科收治的18岁以上严重脓毒症患者63例随机分配入集束化治疗组和对照组,观察两组患者心率(HR)、血压(BP)、中心静脉压(CVP)、中心静脉血氧饱和度(ScvO_2)、动脉血乳酸(LAC)及乳酸清除率的变化。结果:集束化治疗组HR、SBP和DBP与对照组同期比较差异无统计学意义,但集束化治疗组入选后6 h CVP和ScvO_2明显高于对照组同期,LAC明显低于对照组同期(P<0.05),入选后24 h CVP和ScvO_2仍高于对照组同期,LAC仍低于对照组同期,但仅LAC的变化差异具有统计学意义(P<0.05),集束化治疗组6 h和24 h乳酸清除率均明显高于对照组同期,差异具有统计学意义(P<0.01)。结论:集束化治疗可以明显改善严重脓毒症患者早期的循环灌注。
OBJECTIVE: To study the effect of cluster therapy on perfusion and lactate clearance in patients with severe sepsis in ICU. Methods: From October 2007 to December 2009, 63 patients with severe sepsis who were over 18 years old admitted to our department were randomly assigned to the treatment group and the control group. The heart rate (HR), blood pressure (BP) , Central venous pressure (CVP), central venous oxygen saturation (ScvO_2), arterial blood lactate (LAC) and lactic acid clearance. Results: There was no significant difference in the HR, SBP and DBP concentrations between the two groups in the treatment group, but the levels of CVP and ScvO_2 in the bundled group were significantly higher than those in the control group at 6 h <0.05). The levels of CVP and ScvO_2 at 24 h after admission were still higher than those of the control group, but LAC was still lower than that of the control group at the same time point (P <0.05). The differences of LAC between the two groups were statistically significant (P <0.05) h lactic acid clearance rate were significantly higher than the control group over the same period, the difference was statistically significant (P <0.01). Conclusion: Cluster therapy can significantly improve the early circulation of patients with severe sepsis.