抗生素治疗的时间确定了疑似感染性休克的患者中不同的临床表现
Priya A Prasad1, Armond M Esmaili1, Sandra Oreper1
1Division of Hospital Medicine Department of Medicine University of California San Francisco California USA.
Journal of the American College of Emergency Physicians open
|April 10, 2024
概括
立即启动抗生素是感染性休克的关键. 治疗的延迟,即使是早期的低血压,也没有显著改变这项研究中患者的结果.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 紧急医疗 紧急医疗
背景情况:
- 败血症管理指南优先考虑疑似败血症休克的快速抗生素给药.
- 低血压是败血症严重程度的关键指标,但与抗生素启动相比,其精确的时间尚未研究.
- 了解这些时间关系对于优化患者护理和结果至关重要.
研究的目的:
- 调查抗生素时间相对于低血压在疑似败血症休克的患者的影响.
- 根据抗生素开始的时间来描述临床表现和结果的差异.
- 为临床实践提供有关败血症管理协议的信息.
主要方法:
- 从2012年6月到2018年12月,对2219名在急诊室被诊断患有败血症和低血压的成年患者进行了回顾性分析.
- 患者被分为"早期" (低血压前的抗生素),"立即" (0-60分钟后) 和"晚期" (>60分钟后) 治疗组.
- 临床特征,并发症和全身炎症反应综合征 (SIRS) 发病情况在各组之间进行了比较.
主要成果:
- 55%的患者接受了早期,13%的患者接受了立即,32%的患者接受了晚期的抗生素治疗.
- "晚期"组经常出现低血压,但经历了抗生素治疗的显著延迟 (ED后191分钟的中位数).
- 晚期治疗与心力衰竭,肝病和SIRS标准的晚发率较高有关,但调整后的结果在各组之间没有显著差异.
结论:
- 对于疑似败血性休克的呈现和抗生素时间存在显著的异质性.
- 接受延迟抗生素治疗的患者往往有先前存在的疾病,后来发展出感染标志物,可能会延迟识别.
- 尽管呈现和识别有差异,但延迟开始服用抗生素似乎不会对这一队列的败血症结果产生负面影响.
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