Giá trị thang điểm qSOFA, SIRS, NEWS, M-qSOFA sử dụng tại khoa cấp cứu trong đánh giá mức độ nặng nhiễm trùng nặng, sốc nhiễm trùng và thực hiện chiến lược kiểm soát nhiễm trùng theo SSC-2021 tại Bệnh viện Đa khoa Tâm Anh Hà Nội=Validity of qSOFA, SIRS, NEWS, M-qSOFA scores in emergency admissions treated as sepsis, septic shock and implementation international guidelines for management of sepsis and septic shock 2021 at Ha Noi Tam Anh Hospital: Retrospective study

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Tác giả: Thị Băng Đỗ, Ngọc Huệ Hà, Thị Diễm Tuyết Lê

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.34-41

Bộ sưu tập: Metadata

ID: 243930

Thêm vào giỏ

The SSC-2021 were recommended a firsthour management bundle for septic shock such as crystalloid infusion 30ml/kg/first 3 hours, fluid assessment, serum lactate mesuring, blood cultures before antibiotics using. Recommended serum procalcitonin test monitoring sepsis and septic shock. Study design and methods: Retrospective study with adult (≥ 18 years) patients with diagnosed sepsis and septic shock. Patients in the study were defined infectious source, presented q-SOFA score of 2 points or more (SSC-2016). Septic shock was defined a sepsis and identified by a vasopressor requirement to maintain a MAP of 65 mm Hg and serum lactate level greater than 2 mmol/L (>
18 mg/dL) in the absence of hypovolemia. Vital signs were measured immediately in ED. Following, the qSOFA, SIRS, NEWS, SOFA, M-qSOFA were calculated. Using the established cut-off points, we analysed how often alterations in clinical rule scores occurred septic shock. The bundle 1st hour management by SSC-2021 is also recorded and calculated. Results: In admited patients to the ED, There was a statistically significant difference with P<
0.05 between sepsis and septic shock group about NEWS, qSOFA
modified q-SOFA, SOFA. Calculating the cut-off value of these scores in predicting septic shock show the AUC of the NEWS 0.74, the qSOFA 0.84
the SOFA 0.90. Also finding as NEWS score
qSOFA
SOFA have good ability to predict septic shock. The results of implementing 1-hour bundle to control sepsis and septic shock shows that the total fluid infusion in the septic shock patient group reached more 30ml/kg in 3 hours and 100% patients received intravenous antibiotics within the first 3 hours, although only 50% patients received antibiotics within the first hour. 34.6% patients received blood cultures before using antibiotics. Fluid assessment were performed 30.8% in the first hour and 100% in the three hours. Conclusion: This study shows that the NEWS
qSOFA
SOFA score have good ability to predict septic shock. In the septic shock group, 100% pts received IV antibiotics within the first 3 hours, although only 50% pts received antibiotics within the 1st hour. Only 34.6% pts received blood cultures before using antibiotics. Fluid assessment were performed 30.8% in 1st hour and 100% in 3rd hours.Xác định giá trị các thang điểm qSOFA, SIRS, NEWS, SOFA, M-qSOFA trong dự báo sốc nhiễm trùng và nhận xét về sự tuân thủ gói kiểm soát NT nặng, SNT theo khuyến cáo của SSC-2021 tại BVĐK Tâm Anh Hà Nội từ 1/2022 đến 3/2024. Phương pháp: Nghiên cứu mô tả, hồi cứu các bệnh án bệnh nhân (BN) ≥ 18 tuổi, có mã ICD chẩn đoán nhiễm trùng và sốc nhiễm trùng theo định nghĩa SSC-2016 và có vị trí và căn nguyên nhiễm trùng xác định, BN vào khoa Cấp cứu - BVĐK TA Hà Nội. Dấu hiệu sống và các cận LS được đánh giá và ghi nhận tại thời điểm vào khoa Cấp cứu và nhập khoa HSTC trong 3 giờ đầu, tính các thang điểm SIRS, NEWS, APACHEII, qSOFA, M-qSOFA. SOFA. Các biện pháp điều trị giờ 1 và giờ 3 theo SSC cũng được ghi nhận và tính toán. Giá trị cut-off của các thang điểm và AUC, giá trị đường cong ROC được tính toán cho 5 thang điểm ghi nhận trong giờ đầu và 3 giờ đầu. Kết quả: từ 1/2022 đến tháng 3/2024 thu nhận 64 BN. Tuổi trung bình 72,5 ± 16,1. Thời gian khởi phát đến khi nhập viện 50,2 ± 30,9 giờ, tử vong 1 BN SNT chiếm 1,6%. Căn nguyên từ NT hô hấp chiếm cao nhất 54,7%. Điểm đánh giá mức độ nặng khi nhập viện của NEWS
qSOFA
modified q-SOFA và SOFA khác biệt giữa 2 nhóm bệnh có ý nghĩa thống kê với P<
0,05. Khi tính giá trị cut-off của các thang điểm và tính diện tích dưới đường cong AUC tìm độ nhạy và độ đặc hiệu cho thấy điểm NEWS có AUC 0,74
Điểm qSOFA 0,84
Điểm SOFA 0,90
Điểm MqSOFA 0,65
Điểm SIRS 0,55. Như vậy kết quả cho thấy điểm NEWS
qSOFA
SOFA có hiệu suất tốt sử dụng trong chẩn đoán SNT. Về kết quả thực hiện các biện pháp kiểm soát NT nặng/SNT trong 3 giờ đầu cho thấy tổng dịch truyền ở nhóm SNT đạt >
30ml/kg trong 3 giờ và nhiều hơn so với nhóm NT nặng. Nhóm SNT, bệnh nhân được dùng thuốc kháng sinh tĩnh mạch 100% trong 3 giờ đầu, tuy chỉ có 50% BN được dùng thuốc kháng sinh trong giờ đầu tiên. Có 34,6% BN được cấy máu trước khi dùng thuốc kháng sinh. Các biện pháp đánh giá dịch thực hiện trong 3 giờ đầu ở nhóm BN nhiễm trùng nặng 23,7%, ở nhóm SNT 100%, trong đó chỉ 30,8% đánh giá dịch trong giờ đầu. Kết luận: Bệnh nhân NT nặng/SNT vào khoa Cấp cứu được sử dụng các thang điểm đánh giá độ nặng cho thấy NEWS
qSOFA
SOFA có giá trị trong dự báo sốc nhiễm trùng với AUC lần lượt 0,74
0,84
0,9 với P<
0,03. Sự tuân thủ chiến lược điều trị theo SSC-2021 giờ đầu tiên đối với BN sốc nhiễm trùng chưa đạt, chỉ 50% BN được sử dụng thuốc kháng sinh trong giờ đầu, 34,6% BN được cấy máu trước khi sử dụng kháng sinh, 100% được thực hiện các biện pháp đánh giá dịch truyền trong 3 giờ đầu.

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