Effects of early fluid management on prognosis of elderly patients with septic shock / 中国综合临床

ABSTRACT

Objective To investigate the risk factors affecting prognosis in elderly patients with septic shock and explore the effective treatment. Methods A retrospective study of 147 patients with septic shock from the Affiliated Hospital of Hebei United University and Affiliated People's Hospital from Jan. 2011to Jan. 2013 was conducted. Early fluid loading was defined as the administration with an initial fluid bolus within 6 h in ICU. Conservative fluid management was defined as negative fluid balance measured in at least 1 d during the first 3 d as the case group,while the daily fluid balance and cumulative daily fluid balance of the first 3 d was as the control group. The effects of early fluid management on prognosis of elderly patients septic with shock combining the living index within 7 d in ICU were recorded. Results In the case group with 7 d ICU,21. 4%(15 / 70)patients were in progressed and 37. 1%(26 / 70)patients were dead,while 25. 9%(20 / 77)patients were in progressed and 59. 7%(46 / 77)patients were dead in control group(χ2 = 13. 17,P = 0. 00). Univariate analysis showed that APACHEⅡ scores,SIRS score,organ failure,patients with chronic diseases related were associated with 7 d survival rate in elderly patients with septic shock. Multivariate Logistic regression analysis showed that higher APACHEⅡ scores and SIRS score,organ failure,patients with chronic diseases related (have)were the risk factors(OR = 1. 88,5. 34,1. 96 and 4. 76;P < 0. 05). The restrictive fluid management strategy have related with the septic shock patients in elderly that the OR of death rate of fluid management in elderly patients with septic shock was 0. 657(P = 0. 032). Conclusion The prognosis in elderly patients septic with shock is associated with APACHE Ⅱ scores,SIRS score,organ failure,patients with chronic diseases related. Early fluid management can improve to the prognosis of elderly patients with septic shock.