| Partâ… Study on clinical therapy of severe sepsis in abdominal surgeryObjective:To study the early diagnosis of sepsis and to study the therapeutical effect of the combined therapy including early goal-directed therapy,immune regulation,strict blood glucose control,glucocorticoid replacement therapy,small tidal volume mechanical ventilation,kidney replacement therapy on abdominal surgery severe sepsis.Methods:To retrospectively analyze sixty-one patients with abdominal surgery severe sepsis from SICU sickroom of general hospital.All patients were divided into two groups,one was contrast group with regular therapy called experiential therapy group which contains twenty -one patients.The other was treatment group with above-mentioned therapy called combined therapy group which contains forty patients.Through studying case fatality,crystal and colloform fluid of twenty-four hours treatment,urine volume of twenty-four hours,mechanical ventilation Ratio,CRRT Ratio,quantity of organ failure,ratio of one more time resuscitation to evaluate effectivity of combined therapy.Result:At the beginning of morbility,the PCT of the two groups was obviously raised,at the beginning of spsis,monitoring indicatrixes had change.The case fatality of experiential therapy group was 66.7%,and the case fatality of combined therapy group was 32.5%,the case fatality of combined therapy group was abvious lower than the case fatality of experiential therapy group(P=0.011);On the third day,the PCT of combined therapy group was abvious lower than the experiential therapy group:on the first,third,fifth,seventh day,the blood sugar,PCT,quantity of organ failure, mechanical entilation Ventilation Ratio,CRRT Ratio,ratio of one more time anabiotic(p＜0.05);The ratio of organ functional impairment recover,crystal and colloform fluid of twenty-four hours treatment,urine volume of twenty-four hours were of combined therapy group is abvious higher than the experiential therapy group.Conclusion:Close observation of patient's condition,high level of PCT is helpful to early diagnosis of sepsis.The combined therapy including early goal-directed therapy,immune regulation,strict blood glucose control,glucocorticoid replacement therapy,small tidal volume mechanical ventilation,kidney replacement therapy can obviously improve patients' prognosis,cut down mechanical ventilation, ratio of CRRT,and increase the organ functional impairment recovery rate. Partâ…¡Study on prognostic factor of severe sepsis in abdominal surgeryObjective:To analyze changing tendency of risk factor effecting prognosis of severe sepsis in surgery during sepsis course in order to know risk factor' precaution affect for sepsis prognostic.Methods:To retrospectively analyze sixty-one patients with abdominal surgery severe sepsis from SICU sickroom of general hospital.All patients were divided into two groups,one was survival group another was death group.Through comparing clinical index of both group including the ratio of patients which were older than seventy years old,the ratio of foundation diseases which were more than two kinds,the ratio of happening of dual infection,the quantity of organ failure, respiratory function,renal function,Liver function,grume function,lactic acid level, plasma-albumin,blood platelets count,APACHEâ…¡score,et al,to analyze the risk factor effecting surgery severe sepsis prognosis change tendency during sepsis course.In the same time to analyze the doctors' recognition of sepsis and compliance of sepsis treatment guide and the current situation of early diagnosis for sepsis.Result:The ratio of patients which were older than seventy years old,the ratio of foundation diseases which were more than two kinds,the ratio of happening of dual infection,the quantity of organ failure of death group were higher than survival group. On the third day,fifth day,seventh day,the level of oxygen partial pressure and oxygenation index,blood platelets count,clotting time,plasma-albumin level APACHEâ…¡score of survival group were higher than death group(P＜0.05);On the third day,fifth day,seventh day lactic acid,AST,ALT,BUN,CR of survival group were higher than death group(P＜0.05).At the beginning of sepsis the pressure O2 and oxygenation index of death group turned high,but the lactic acid of blood level have kept high,then the pressure O2 and oxygenation index one more time descended.Now the recognition to sepsis is deficiency,the compliance to sepsis treatment guide is low,so both of them affect the early diagnosis of sepsis greatly.Conclusion:Patients which were older than seventy years old,the ratio of foundation diseases which were more than two kinds,the ratio of happening of dual infection,the quantity of organ failure,all of them hint unfavourable prognosis;the lactic acid of blood level have kept high,respiratory function disorders,renal function disorders,Liver function disorders,coagulation disorders,APACHEâ…¡score keep descending can effect the prognosis of patient with sepsis.The blood platelets count, plasma-albumin level keeping low can increase the ratio of death of patient with sepsis.In addition,the doctors' recognition of sepsis and compliance of sepsis treatment guide and the current situation of early diagnosis for sepsis also affect the prognosis of patient with sepsis. |
