ลักษณะทางคลินิก การวินิจฉัย การส่งตรวจทางห้องปฏิบัติการ การรักษาและผลลัพธ์ในผู้ป่วยที่มีภาวะติดเชื้อในกระแสเลือด โรงพยาบาลด่านช้าง

ผู้แต่ง

  • Rungpailin Buranagan, M.D. กลุ่มงานอายุรกรรม โรงพยาบาลด่านช้าง จังหวัดสุพรรณบุรี

คำสำคัญ:

ปรัชญาของเศรษฐกิจพอเพียง, โครงการต้นแบบเศรษฐกิจพอเพียง, การพัฒนาคุณภาพชีวิต, กำลังพลกองทัพภาคที่ 2

บทคัดย่อ

Objective: By study the clinical diagnosis, investigation, treatment and outcome to find the weaknesses in the care of patients. To develop proper sepsis guideline for Danchang Hospital.

Methods: This was a retrospective analysis of adult in-patients who diagnosed sepsis in Danchang Hospital between 1 July to 31 December 2556. Data collection from Danchang hospital’s computer system, comprised of patients’ demographic data, diagnosis, investigation, treatment and outcome then analyzed using Chi-square test or Fisher’s exact.

Results: 50 patients was included in this study, there were male 18 and female 32, mean age 63 years. Common underlying diseases were hypertension and diabetes mellitus. The common infectious sites were the digestive system, it ranked first 38% and skin infection was 30%. Hemoculture was taken only 58% but results were no growth 75% and 26% of patients did not have any hemoculture or culture from other sites. Diagnostic data was delayed more than one hour from the time of visiting ER or OPD department 64% and patients who had received antibiotics within the first hour was 72%. Diagnosed severe sepsis / Septic shock group was 62% received fluid more than 800 ml/1 hr and 76% received vasopressure/inotropic drug. Which was Norepinephrine 72% treatment 9 patients died, representing 18%. Patients who received antibiotics within 1 hour and who received more than 800 ml of fluid within 1 hour have lower mortality rates than those who not received. Mortality rate of severe sepsis/septic shock patients who received Norepinephrine, Dopamine were not significant different (9%, 11%).

Conclusions: Received antibiotics within 1 hour after septic work up, received more than 800 ml of fluid within 1st hour and achieved Early goal-directed therapy show lower mortality rates in the treatment of patients with severe sepsis/septic shock. In addition to vasopressor/inotropic drugs, norepinehrine; lower death rate . Delayed in diagnosis and incompleted septic work up was two pitfalls in the care of patients with sepsis in Danchang Hospital. These datas can lead to further improve patient care process.

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Author Biography

Rungpailin Buranagan, M.D., กลุ่มงานอายุรกรรม โรงพยาบาลด่านช้าง จังหวัดสุพรรณบุรี

ว.ว. อายุรศาสตร์

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เผยแพร่แล้ว

2018-05-28