[脓毒症捆绑治疗管理和实践方案的构建与应用]。

Q3 Medicine
Yanjie Yang, Xin Gu, Hu Peng, Ling Yang, Xiangyou Yu, Li Zhang
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引用次数: 0

摘要

方法方法:(1)脓毒症捆绑治疗管理与实践方案的构建:成立项目组,进行文献综述、专家遴选、问卷编制与发放、整理、分析专家意见,确保研究全过程的质量控制。2022 年 10 月至 11 月,开展专家信访咨询,通过现场填写、微信等方式发放和回收问卷。采用李克特五点量表对各项目进行评分。(2)方案的临床应用:回顾性选取新疆医科大学第一附属医院重症医学科(ICU)2022年1月至7月收治的90例脓毒症患者作为对照组,采用脓毒症常规捆绑治疗及护理策略。前瞻性选取2023年1月至7月收治的90例脓毒症患者作为干预组。在对照组治疗和护理策略的基础上,采用德尔菲探询法构建脓毒症捆绑治疗管理和实践方案。结果:(1)脓毒症捆绑治疗管理与实践方案的构建:最终方案由4个一级指标、15个二级指标和34个三级指标组成。两轮调查问卷的回复率均为100%。专家权威系数分别为 0.948 和 0.940。各项目变异系数分别为 0-0.287 和 0-0.187。Kendall's W 系数分别为 0.242 和 0.249,具有统计学意义(P 均小于 0.05)。(2)方案的临床应用:两组患者的年龄、性别、感染部位、病原体种类、机械通气时间、序贯器官衰竭评估(SOFA)、急性生理学和慢性健康评估 II(APACHE II)等基线数据差异无统计学意义。干预组的 1 小时、3 小时和 6 小时捆绑完成率均高于对照组(1 小时捆绑完成率为 53.30% 对 21.30%):1 小时捆绑完成率:53.30% 对 21.10%,3 小时捆绑完成率:92.20% 对 80.00%:92.20% 对 80.00%,6 小时捆绑完成率:88.89% 对 65.00%:88.89%对65.56%,所有P均<0.05)。两组患者的 C 反应蛋白(CRP)、白细胞计数(WBC)、降钙素原(PCT)和白细胞介素-6(IL-6)水平在不同时间点、组间和交互效应中均有显著统计学差异。与对照组相比,干预组的ICU住院时间明显缩短[天数:7.00(4.00,14.00)vs 8.00(7.00,20.00),P<0.01],ICU住院费用明显减少[万元:4.63(3.36,6.19)vs 6.46(3.32,11.34),P<0.05]。干预组的 28 天死亡率低于对照组(33.33% vs. 46.67%),但差异无统计学意义(P > 0.05):构建的脓毒症捆绑治疗管理与实践方案可提高捆绑治疗的完成率,缩短脓毒症患者的ICU住院时间,降低ICU住院费用,并有降低28天死亡率的趋势。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Construction and application of sepsis bundle therapy management and practice program].

Objective: To construct a bundled therapy management and practice program for sepsis and explore its clinical application effect.

Methods: (1) Construction of sepsis bundled therapy management and practice program: a project team was established to conduct literature review, select experts, compile and distribute questionnaires, organize, analyze expert opinions, and ensure quality control throughout the research process. From October to November 2022, expert letter consultation was carried out, and questionnaires were distributed and collected by on-site filling and WeChat. The Likert 5-point scale was used to rate each item. (2) Clinical application of the protocol: ninety patients with sepsis admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Xinjiang Medical University from January to July 2022 were retrospectively selected as the control group, and routine bundle treatment and nursing strategy for sepsis were adopted. Ninety patients with sepsis admitted from January to July 2023 were prospectively selected as the intervention group. Based on the treatment and nursing strategy of the control group, sepsis bundled therapy management and practice program constructed using the Delphi inquiry method was implemented. The completion rate of 1-hour, 3-hour and 6-hour bundle, the levels of inflammatory indicators at 1, 3, 7 days of treatment, and prognostic indicators were compared between the two groups.

Results: (1) Construction of sepsis bundled therapy management and practice program: the final plan consists of 4 primary indicators, 15 secondary indicators and 34 tertiary indicators. The response rates for both rounds of inquiry questionnaires were 100%. The coefficients of expert authority value were 0.948 and 0.940, respectively. The coefficient of variation for each item was 0-0.287 and 0-0.187, respectively. Kendall's W coefficients were 0.242 and 0.249, respectively, with statistical significances (all P < 0.05). (2) Clinical application of the protocol: there were no statistically significant differences in baseline data such as age, gender, infection site, pathogen species, duration of mechanical ventilation, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation II (APACHE II) between the two groups. The completion rate of 1-hour, 3-hour and 6-hour bundle in the intervention group were higher than those in the control group (1-hour bundle completion rate: 53.30% vs. 21.10%, 3-hour bundle completion rate: 92.20% vs. 80.00%, 6-hour bundle completion rate: 88.89% vs. 65.56%, all P < 0.05). The levels of C-reactive protein (CRP), white blood cell count (WBC), procalcitonin (PCT), and interleukin-6 (IL-6) in two groups of patients showed statistically significant differences at different time points, between groups, and in interaction effects. Compared with the control group, the length of ICU stay in the intervention group was significantly shortened [days: 7.00 (4.00, 14.00) vs. 8.00 (7.00, 20.00), P < 0.01], and the hospitalization cost of ICU was significantly reduced [ten thousand yuan: 4.63 (3.36, 6.19) vs. 6.46 (3.32, 11.34), P < 0.05]. The 28-day mortality in the intervention group was lower than that in the control group (33.33% vs. 46.67%), but the difference was not statistically significant (P > 0.05).

Conclusions: The constructed bundled therapy management and practice program for sepsis can improve the completion rate of bundle treatment, shorten the length of ICU stay of sepsis patients, reduce the hospitalization cost in ICU, and have a tendency to reduce the 28-day mortality.

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Zhonghua wei zhong bing ji jiu yi xue
Zhonghua wei zhong bing ji jiu yi xue Medicine-Critical Care and Intensive Care Medicine
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