智能预警系统在脓毒症休克患者集束化治疗中的应用效果

陈晓蕾; 吴卉卉; 张其霞; 木晶晶; 吴晓晓

doi:10.16766/j.cnki.issn.1674-4152.003853

智能预警系统在脓毒症休克患者集束化治疗中的应用效果

doi: 10.16766/j.cnki.issn.1674-4152.003853

温州医科大学附属第一医院ICU，浙江温州 325000

基金项目:

浙江省卫生健康科技计划项目 2021KY792

温州市科技局基础性科研项目 Y20220577

详细信息

通讯作者:
张其霞，E-mail：zhangqixia363636@163.com

中图分类号: R631.2 R605.971
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出版历程
- 收稿日期: 2024-03-19
- 网络出版日期: 2025-02-13

Effectiveness of an intelligent warning system in bundle therapy for septic shock patients

Department of ICU, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨智能预警系统在脓毒症休克患者中的应用效果，以期能改善患者的治疗效果。方法以2022年1—12月于温州医科大学附属第一医院综合ICU病房治疗的129例脓毒症休克患者为对照组，以2023年2—12月智能预警系统实施后的117例患者为观察组。对照组实施常规集束化治疗综合管理，观察组采用智能预警系统进行疾病管理。结果 2组1 h和3 h集束化治疗措施完成率[1 h完成率：98/117(83.8%) vs. 90/129(69.8%)；3 h完成率：104/117(88.9%) vs. 101/129(78.3%)]，差异均有统计学意义(P < 0.05)。6 h措施完成率差异无统计学意义(P>0.05)。观察组乳酸水平低于对照组，而6 h乳酸清除率高于对照组，差异有统计学意义(P < 0.05)。2组治疗后的平均动脉压和中心静脉压差异无统计学意义(P>0.05)。观察组的中心静脉血氧饱和度和呼气末二氧化碳分压均明显高于对照组(P < 0.05)。观察组ICU住院时间[(11.73±2.67)d]明显短于对照组[(13.04±2.85)d, t=3.722, P < 0.05]；2组28 d病死率差异无统计学意义(P>0.05)。医护人员预警系统开展前后的满意度得分差异有统计学意义(P < 0.05)。结论智能预警系统可提升脓毒症休克患者集束化治疗措施完成率，降低血清乳酸水平，提高6 h乳酸清除率，提升医护人员的工作满意度，值得临床推广与应用。
- 脓毒症休克 /
- 集束化治疗 /
- 智能预警系统
Abstract: Objective To explore the effect of an intelligent warning system on the management of Intensive Care Unit (ICU) patients with septic shock and to improve the treatment effect. Methods A total of 129 patients with septic shock in the ICU of the First Affiliated Hospital of Wenzhou Medical University from January to December 2022 were taken as the control group, and 117 patients from February to December 2023 were taken as the observed group. The control group implemented the comprehensive management of conventional bundle therapy, while the observed group adopted the intelligent warning system of septic shock for disease management. Results The completion rate of 1 h and 3 h bundle therapy in the observation group was higher than that of the control group [1 h completion rate: 98/117 (83.8%) vs. 90/129(69.8%); 3 h completion rate: 104/117 (88.9%) vs. 101/129 (78.3%), P < 0.05]. There was no significant difference in the completion rate of 6 h treatment (P>0.05). The lactate level in the observation group was lower than that of the control group, while the 6 h lactate clearance rate was higher than that of the control group (P < 0.05). There was no significant difference between mean arterial pressure and central venous pressure in the two groups (P>0.05). The central venous oxygen saturation and end-tidal partial carbon dioxide pressure in the observation group were significantly higher than that in the control group (P < 0.05). The length of ICU stay in the observation group [(11.73±2.67) d] was shorter than that in the control group [(13.04±2.85) d, t=3.722, P < 0.05]. There was no significant difference in 28 d mortality in the two groups (P>0.05). There was a statistically significant improvement in satisfaction scores for medical staff after implementing the early warning system (P < 0.05). Conclusion The intelligent warning system improves the completion rate of bundle treatment for septic shock patients, reduces the serum lactate levels, enhances the 6 h lactate clearance rate, and increases the medical staff satisfaction, making it worthy for clinical promotion and application.
- Septic shock /
- Bundle therapy /
- Intelligent warning system

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表 1 2组脓毒症休克患者基本资料比较

Table 1. Comparison of general information in two groups of patients with septic shock

组别	例数	年龄 (x±s，岁)	性别(例)		APACHEⅡ 评分(x±s，分)	感染部位(例)
组别	例数	年龄 (x±s，岁)	男性	女性	APACHEⅡ 评分(x±s，分)	肺部	腹腔	血流	其他
对照组	129	59.91±7.33	71	58	19.78±4.11	57	23	21	28
观察组	117	61.04±7.59	61	56	20.31±4.15	50	19	18	30
统计量		1.185^a	0.208^b		1.005^a	0.555^b
P值		0.237	0.649		0.316	0.907
注：^a为t值，^b为χ²值。

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表 2 2组脓毒症休克患者集束化治疗结束后6 h血氧代谢相关指标比较(x±s)

Table 2. Comparison of blood oxygen metabolism-related indices 6 hours after bundle therapy in two groups of septic shock patients(x±s)

组别	例数	乳酸 (mmol/L)	6 h乳酸清除率 (%)	MAP (mmHg)	CVP (mmHg)	ScvO₂ (%)	ETCO₂ (mmHg)
对照组	129	3.67±0.87	25.36±5.13	69.57±7.95	10.84±1.94	68.45±7.24	34.58±6.33
观察组	117	3.38±0.82	27.64±5.27	70.26±8.27	11.16±2.18	71.12±7.39	36.26±6.41
t值		2.691	3.432	0.666	1.211	2.857	2.065
P值		0.008	0.001	0.506	0.227	0.005	0.040

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表 3 2组脓毒症休克患者ICU住院时间及28 d病死率比较

Table 3. Comparison of ICU stay and 28-day fatality between two groups of septic shock patients

组别	例数	ICU住院时间(x±s，d)	28 d病死[例(%)]
对照组	129	13.04±2.85	23(17.8)
观察组	117	11.73±2.67	18(15.4)
统计量		3.722^a	0.264^b
P值		< 0.001	0.607
注：^a为t值，^b为χ²值。

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