RESUMO
Objective To compare the clinical efficacy of lactated Ringer's (LR) and normal saline (NS) in treating patients with septic shock. Methods The clinical data of 198 patients with septic shock who received fluid resuscitation in the Intensive Care Unit of Quzhou People's Hospital from January 2014 to January 2016 were retrospectively analyzed. These patients were divided into NS group (n=100) and LR group (n=98) according to fluids used. The amounts of trial fluid,other liquids,and blood products and the average total fluid volume were recorded. The oxygenation index (PO/FiO),mean artery pressure (MAP),central venous pressure (CVP),and B-type natriuretic peptide (BNP) before and after treatment as well as the early goal-directed therapy (EGDT) 8 h (EGDT8),EGDT 24 h recovery rate,EGDT recovery time,28-day mortality rate were compared. Other secondary outcomes including bleeding,allergic reaction,acute kidney injury (AKI),venous blood filtration (RRT) rate,hyperkalemia,and ICU stay were also recorded. The 28-day survival rate was calculated using the Kaplan-Maier method,and the difference in survival rate was compared by log-rank test. Results The two groups showed no significant difference in gender,age,body weight,source of admission to ICU,procalcitonin level,source of sepsis,Acute Physiology and Chronic Health Evaluation Ⅱ score,number of AKI patients,amount of white blood cells,and C-reactive protein level (all P>0.05). The amount of blood products on the first day [(782±357)ml vs.(606±273)ml;t=2.044,P=0.046] and the average total amount of liquid on the first three days [(5470±1078)ml vs.(5092±929) ml;t=2.640,P=0.009] were significantly higher in NS group than in LR group. The amount of trial fluid and the volumes of other fluids were not significantly different (both P>0.05). The PO/FiO,MAP,CVP,and BNP levels significantly increased after treatment in both groups (all P<0.05);however,they were not significantly different between LR group and NS group at different time points before and after treatment (all P>0.05). The incidences of hyperlactacidemia (86.0% vs.71.4%,OR:2.457,95%CI:1.202-5.023,P=0.012) and hyperchloremia (25.0% vs.13.2%,OR:2.179,95%CI:1.041-4.562,P=0.036) were significantly higher in NS group than in LR group. These two groups showed no significant difference in EGDT8,24 h recovery rate,EGDT recovery time,28-day mortality rate,AKI,RRT rate,hyperkalemia,and ICU stay (all P>0.05). Kaplan-Meier survival analysis showed that the 28-day survival rate was not significantly different (χ log-rank=0.012,P=0.911). Conclusion When liquid resuscitation is applied in patients with septic shock,the use of LR can lower blood transfusion requirement on the first day and total liquid dosage on the first three days (compared with NR), along with lower incidences of hyperlactacidemia and hyperchloremia,although there was no significant difference in the 28-day mortality rate.
RESUMO
Objective To compare the clinical outcomes of continuous chest compressions (CCP) or interrupt chest compression (ICP) for the cardiac arrest patients. Methods Totally 114 adult patients with out-of-hospital non-trauma-related cardiac arrest that needed cardiopulmonary resuscitation (CPR) in Quzhou People's Hospital from January 2014 to January 2017 were enrolled in this study. Patients who divided into CCP group (n=70) and ICP group (n=44) according to the maneuvers. The clinical data of these two groups were collected and compared. Results The chest-compression fraction was higher in CCP group than in ICP group (0.85±0.05 vs. 0.75±0.06,t=9.868,P=0.000),and the rate of chest-compression pause per minute was significantly lower in CCP group (3.5±1.6 vs. 6.9±3.8,t=-10.669,P=0.000). The interval from arrival at a first aid location to CPR,duration of CPR,electric defibrillation frequency,airway establishment,intubation time,and use of first-aid drugs were not statistically significant (all P>0.05). Significantly lower proportion of patients in CCP group were transported to a hospital (42.8% vs. 56.8%,Χ=0.198,P=0.032). The proportion of patients achieving recovery of spontaneous circulation (ROSC) in CCP group were significantly lower than in ICP group (28.5% vs.47.7%,Χ=0.191,P=0.038). The proportion of patients who got successful resuscitation in CCP group was significantly lower than in ICP group (20.0% vs. 38.6%,Χ=4.470,P=0.029). The proportion of patients who survived and were discharged was significantly lower in CCP group than in ICP group (8.6% vs.22.7%,Χ=0.487,P=0.041). There was no significant difference between these two groups in ROSC time,proportion of survivors one month after discharge,proportion of survivors six months after discharges,and neurological outcomes (all P>0.05). Among the survivors,2 patients had ST-elevation myocardial infarction,1 had rheumatic heart disease,2 had non-ST segment elevations myocardial infarction,and 1 had dilated cardiomyopathy. Multivariate Cox proportional hazard regression analysis was used to analyze the independent factor of prognosis. The time from cardiac arrest to CPR (HR=1.047,95% CI=1.003-1.093,P=0.034),the time from CPR to ROSC (HR=1.021,95% CI=1.003-1.038,P=0.020),and Glasgow Coma Scale (GCS) 1 score (HR=1.551,95% CI=1.022-2.355,P=0.039) were the independent risk factor for deaths within 180 days after discharge. Conclusion Long interval from cardiac arrest to CPR,long interval from CPR to ROSC,and a Glasgow Coma Scale score of>1 are the independent risk factors of deaths within 180 days after discharge. Therefore,the survival outcomes of CCP may not be superior to ICP in patients with out-of-hospital cardiac arrest.
