抗感染督导治疗对脓毒症患者预后影响的研究申贵彭翔秦光梅摘要：目的觀察督导抗感染治疗策略对脓毒症患者预后的影响，为临床提供实用、安全、有效的综合抗感染治疗指导。方法收集2016年4月～2017年1月在我院呼吸内科住院的脓毒症患者50例，根据随机数字表法分为督导治疗组26例和对照组24例。对照组的患者进行常规治疗，督导治疗组患者接受抗感染方案的监督指导。在患者的病程中记录抗感染治疗后患者的症状变化及抗感染疗效评价，比较两组患者的细菌清除率，抗感染效果评价，7d及14d死亡率;入院后第1，2，3，7，14天心肌酶及心肌标志物、血尿素氮及肌酐、凝血功能;入院7d的液体入量、平均动脉压、降钙素原。结果两组患者在平均住院时间、平均医疗费用、细菌/真菌检出率，抗生素使用时间、抗菌药物使用强度、7d及14d死亡率比较，差异无统计学意义（P>0.05）。督导治疗组细菌清除率及抗感染有效率均优于对照组（P0.05），但督导治疗组恢复较对照组更平稳迅速。两组患者第1，2，3，7天的SOFA评分及7d液体入量比较，差异无统计学意义（P>0.05）。两组患者入院治疗24h后降钙素原比较，差异有统计学意义（P关键词：抗感染督导治疗;脓毒症;细菌清除率：R459.7：ADOI：10.3969/j.issn.1006-1959.2019.01.026：1006-1959（2019）01-0082-06StudyontheEffectofAnti-infectiveSupervisiononthePrognosisofPatientswithSepsisSHENGui，PENGXiang，QINGuang-mei（DepartmentofRespiratoryMedicine，YongchuanHospital，ChongqingMedicalUniversity，Chongqing402160，China）Abstract：ObjectiveToobservetheeffectofsupervisinganti-infectivetreatmentstrategyontheprognosisofpatientswithsepsis，andprovidepractical，safeandeffectivecomprehensiveanti-infectivetreatmentguidancefortheclinic.MethodsAtotalof50patientswithsepsisadmittedtoourDepartmentofRespiratoryMedicinefromApril2016toJanuary2017wereenrolled.Accordingtotherandomnumbertable，26patientswereinthesupervisiongroupand24patientsinthecontrolgroup.Patientsinthecontrolgroupunderwentroutinetreatment，andpatientsinthetreatmentgroupweresupervisedandguidedbytheanti-infectiveprogram.Inthecourseofthepatient'sdisease，thepatients'symptomsandanti-infectiveeffectswereevaluated.Thebacterialclearancerateandanti-infectiveeffectwerecomparedbetweenthetwogroups.Themortalityratewas7dand14d.Myocardialenzymesandmyocardialmarkers，bloodureanitrogenandcreatinine，coagulationfunctiononthe1st，2nd，3rd，7th，and14thdafteradmission;liquidintake，meanarterialpressure，andprocalcitoninat7dafteradmission.ResultsTherewerenosignificantdifferencesintheaveragelengthofhospitalstay，averagemedicalcost，bacterial/fungusdetectionrate，antibioticusetime，antibacterialuseintensity，and7dand14dmortalitybetweenthetwogroups（P>0.05）.Thebacterialclearancerateandanti-infectionefficiencyofthesupervisedtreatmentgroupwerebetterthanthoseofthecontrolgroup（P<0.05）.Inthetreatmentgroup，theinfectionsitewas73.07%inthelungs，15.38%inthebiliarytract，and11.55%intheabdomen，skinandblood.Themostimportantinfectionsiteswerelungs，accountingfor73.07%and50.00%，respectively.ThetopthreebacterialcultureswerePseudomonasaeruginosa，AcinetobacterbaumanniiandKlebsiellapneumoniae.Therewerenosignificantdifferencesinmyocardialenzymes，myocardialmarkers，bloodureanitrogen，creatinineandcoagulationbetweenthe1st，2nd，3rd，7thand14thdafteradmission（P>0.05），butthecontrolgrouprecoveredcomparedwiththecontrolgroupismorestableandfast.TherewasnosignificantdifferenceinSOFAscoresand7dfluidintakebetweenthetwogroupsondays1，2，3，and7（P>0.05）.Therewasastatisticallysignificantdifferencebetweenthetwogroupsofpatientsafter24hofad...