目的   探讨脓毒性休克患者肿瘤坏死因子相关受体6 （TRAF6）、胆碱酯酶（ChE）及急性生理学和慢性健康状况评价Ⅱ（APACHE Ⅱ）对预后不良的预测价值。方法   回顾分析2023年2月—2024年3月于某院ICU病区收治的226例脓毒性休克患者的临床资料，基于患者预后情况分为预后良好组（n=151）以及预后不良组（n=75）。回顾226例脓毒性休克患者入院时及治疗后的TRAF6、ChE表达变化，并记录患者APACHEⅡ评分和序贯器官功能衰竭评估（SOFA）评分动态变化；比较并分析两组患者详尽的临床资料，探讨TRAF6、ChE联合APACHE Ⅱ评分之间的关联性以及上述指标对脓毒性休克患者预后情况的临床评估价值。采用Logistic回归来分析对脓毒性休克患者生存状况产生影响的潜在因素。结果   多因素Logistic回归分析，年龄、APACHE Ⅱ评分、SOFA评分、机械通气时间、TRAF6与ChE表达水平均是影响患者预后的独立危险因素（P＜0.05）；受试者操作特征曲线分析显示，年龄、APACHE Ⅱ评分、机械通气时间、SOFA评分、TRAF6、ChE表达水平联合预测脓毒性休克患者预后不良的曲线下面积为0.925，高于单独检测的0.689、0.783、0.794、0.781、0.708、0.827。结论   临床需要及时识别高龄、长时间机械通气时间、高APACHE Ⅱ与SOFA评分、高TRAF6和ChE表达水平的高风险患者，TRAF6、ChE表达水平、SOFA评分、APACHE Ⅱ评分可作为评估脓毒性休克患者预后情况的临床指标，联合应用能进一步提升临床价值。

      Objective  To explore the predictive value of tumor necrosis factor receptor associated factor 6（TRAF6），cholinesterase（ChE）and Acute Physiology and Chronic Health Evaluation II scove（APACHE II）for adverse prognosis in patients with septic shock．Methods  The clinical data of 226 patients with septic shock admitted to the Intensive Care Unit（ICU） of a hospital from February 2023 to March 2024 were retrospectively analyzed，and the patients were divided into a good prognosis group（n=151）and an adverse prognosis group（n=75）based on their prognosis．The expression of TRAF6 and ChE in 226 patients with septic shock was reviewed at admission and after treatment，while the dynamic changes of APACHE  II score and Sequential Organ Failure Assessment（SOFA）score were recorded．Detailed clinical data of the two groups were compared and analyzed to explore the correlation between TRAF6，ChE，APACHE II scores and the clinical evaluation value of the above indexes in the prognosis of patients with septic shock．Logistic regression was used to analyze the potential factors affecting the survival of septic shock patients．Results  Multiple Logistic regression analysis revealed that age，APACHE II score，SOFA score，mechanical ventilation time，TRAF6 and ChE expression levels were independent risk factors for prognosis（P＜0.05）．Receiver Operating Characteristic（ROC）curve analysis showed that the area under curve（AUC）was 0.925，which was higher than single index prediction（0.689，0.783，0.794，0.781，0.708 and 0.827）．Conclusions  High-risk patients with advanced age，prolonged mechanical ventilation，high APACHE II and SOFA scores，and high TRAF6 and ChE expression levels need to be identified in time．TRAF6，ChE expression levels，SOFA scores，and APACHE  II scores can be used as clinical indicators to evaluate the prognosis of septic shock patients．The combined application of those four indicators can further improve the clinical value．

目的 观察阶梯式呼吸管理策略在改善感染性休克伴急性肺损伤（ALI）患者中的价值。方法 纳入我院2019年1月—2020年12月收治的感染性休克伴ALI患者共146例为研究对象,数字表法随机分为观察组（73例）与对照组（73例）。对照组常规护理方案,观察组阶梯式呼吸管理,对比干预前后患者心肺功能的差异。结果 观察组平均动脉压、PaCO₂水平低于对照组,心脏指数、中心静脉压、血管外肺水指数、PaO₂与氧合指数高于对照组（P<0.05）;观察组复苏成功率与临床总有效率高于对照组,复苏时间与呼吸平稳时间低于对照组（P<0.05）;观察组气管切开率、有创呼吸机使用率及呼吸机相关性肺炎与气道并发症发生率均低于对照组（P<0.05）。结论 感染性休克并急性肺损伤患者建立阶梯化呼吸管理策略能够显著改善患者的心肺功能,提高临床复苏效果,降低相关并发症风险。

Objective To observe the value of stepwise respiratory management strategy in improving patients with septic shock and acute lung injury（ALI）．Methods A total of 146 patients with septic shock and ALI treated in our hospital from January 2019 to December 2020 were included as the research objects．They were randomly divided into observation group（73 cases）and control group（73 cases）by digital table method．The control group received routine nursing plan,and the observation group received stepwise respiratory management．The differences of cardiopulmonary function before and after the intervention were compared．Results The levels of mean arterial pressure,PaCO₂ in the observation group were significantly lower than those in the control group,cardiac index,central venous pressure,extravascular lung water index,PaO₂ and oxygenation index in the observation group were significantly higher than those in the control group（P<0.05）．The success rate of resuscitation and total clinical effective rate in the observation group were significantly higher than those in the control group,and the resuscitation time and respiratory stability time in the observation group were significantly shorter than those in the control group（P<0.05）．The tracheotomy rate,the rate of using invasive ventilator and the incidence of ventilator associated pneumonia and airway complications in the observation group were lower than those in the control group（P<0.05）．Conclusions The establishment of stepwise respiratory management strategy in patients with septic shock and ALI can significantly improve their cardiopulmonary function,improve the effect of clinical resuscitation and reduce the risk of related complications.

目的 探讨无创血流动力学监测(non-invasive cardiac output monitoring,NICOM)在儿童脓毒性休克早期液体复苏的临床应用评价。方法 选取2019年1月—2020年6月期间在我院PICU患儿诊断为儿童脓毒性休克61例,随机分为对照组(未接受NICOM监测29例)和干预组(接受NICOM监测32例),记录液体复苏后6、12、24小时血气分析(pH值、剩余碱、乳酸)、尿量以及病死率、NICOM监测(CO、CI、SVR、SV、SVRI、HR、MAP)等结果。结果 液体复苏6 小时后两组HR、MAP、乳酸、剩余碱、尿量比较无统计学差异 (P>0.05),液体复苏12 h后干预组乳酸较对照组降低,差异有统计学意义(P<0.05);液体复苏24 h后两组HR、MAP、乳酸、剩余碱及尿量比较,差异均有统计学意义 (P<0.05)。干预组治疗后12 h在CO、CI、SVR、SV、SVRI、HR、MAP较治疗前改善,差异均有统计学意义(P<0.05),干预组治疗后24 h在CO、CI、SVR、SV、SVRI、HR、MAP较治疗前改善,差异均有统计学意义(P<0.05)。结论 NICOM具有敏感度及准确率高,且操作简单,可有效用于指导脓毒性休克早期液体复苏,针对个体化治疗提供客观依据,正确指导容量管理,具有科学实用价值,值得推广。

Objective To evaluate the clinical application of non-invasive cardiac output monitoring (NICOM) for early fluid resuscitation in children with septic shock. Methods 61 children diagnosed with septic shock in the PICU at our hospital between January 2019 and June 2020 were randomly divided into a control group (29 without NICOM monitoring) and an intervention group (32 with NICOM monitoring), and the results of blood gas analysis (pH,lactate and residual base), urine volume, and mortality, and NICOM monitoring (CO, CI, SVR, SVRI, HR, and MAP) were recorded at 6, 12, and 24 h after fluid resuscitation. Results There was no statistically significant difference in HR, MAP, lactic acid, residual base and urine volume between the two groups after 6 h of fluid resuscitation (P>0.05), and lactic acid was lower in the intervention group than that in the control group after 12 h of fluid resuscitation (P<0.05); the differences in HR, MAP, lactic acid, residual base and urine volume between the two groups after 24 h of fluid resuscitation were all statistically significant (P<0.05). The differences were statistically significant (P<0.05) in CO, CI, SVR, SVI, HR, and MAP at 12 h and at 24 h after treatment in the intervention group compared with that of the pre-treatment (P<0.05). Conclusion NICOM has high sensitivity and accuracy and it can be operated in simple processes. It may be effectively applied to guide the early fluid resuscitation of septic shock. It also provides Objective evidence for individualized treatment and correctly guides volume management. Its scientific and practical value makes it worth promoting.

       目的   探讨碳酸氢钠林格液联合乳酸靶向复苏对感染性休克患者的应用效果。方法   选取中国人民解放军联勤保障部队第九八八医院2019年1月—2023年12月收治的80例感染性休克患者，应用随机数字表法将其分为观察组与对照组，均为40例。对照组患者采用复方氯化钠溶液进行液体复苏，观察组患者采用碳酸氢钠林格液联合乳酸靶向复苏。对比两组患者复苏前与复苏后24 h的静脉血氧饱和度（SvO₂）、平均动脉压（MAP）、心脏指数（CI）、心率（HR）等相关生命体征变化，血乳酸、pH值、血钠（Na⁺ ）、血氯（Cl^- ）、碳酸氢根离子（HCO₃^-）水平变化，对比两组患者症状体征消失时间、意识恢复时间、机械通气时间、ICU住院时间、总住院时间及预后不良情况与并发症发生率。结果   复苏后两组SvO₂、MAP、CI均升高，且观察组的SvO₂为（73.62±6.24）%，MAP为（75.26±11.42）mmHg，CI为（3.62±0.66）min/m² ，均高于对照组的（66.85±8.32）%、（68.51±8.37）mmHg 和（3.16±0.35）min/m² ，而HR均降低，其中观察组为（113.26±12.37）次/分，低于对照组的（122.62±12.73）次/分，比较差异有统计学意义（t=4.117，P＜0.001；t=3.015，P=0.003；t=3.894，P＜0.001；t=3.335，P＜0.001）。复苏后两组血乳酸、Cl^- 均降低，pH值、Na⁺ 、HCO₃^-均升高，观察组血乳酸为（1.46±0.52）mmol/L，低于对照组的（2.25±0.32）mmol/L，比较差异有统计学意义（t=8.183，P＜0.001），但两组pH值、Na⁺ 、Cl^- 、HCO₃^-水平对比差异无统计学意义（P＞0.05）。观察组症状体征消失时间为（2.34±0.58）d、意识恢复时间为（1.15±0.27）d、机械通气时间为（5.82±1.08）d、ICU住院时间为（11.85±2.28）d、总住院时间为（23.15±4.26）d，均低于对照组的（3.54±0.72）（2.95±0.34）（10.35±2.12）（15.12±3.23）（27.24±6.37）d，比较差异有统计学意义（t=8.209，P＜0.001；t=26.221，P＜0.001；t=12.042，P＜0.001；t=5.231，P＜0.001；t=3.376，P＜0.001）。观察组多器官功能障碍综合征、肺水肿、脑水肿、再次休克、死亡等不良预后发生率低于对照组（7.50% vs 32.50%；χ ² =7.810，P=0.005）。结论   碳酸氢钠林格液联合乳酸靶向复苏可稳定感染性休克患者生命体征，降低乳酸水平，改善患者预后，缩短住院时间，且能够辅助降低患者不良预后发生率。

       Objective  To explore the application effect of sodium bicarbonate Ringer’s solution combined with lactate targeted resuscitation on patients with septic shock．Methods  A total of  80  patients with  septic  shock admitted to the  988 Hospital，Joint Logistic Support Force of the Chinese People’s Liberation Army from January 2019 to December 2023 were selected and divided into observation group and control group by random number table method，with 40 cases in both groups．The control group was treated with compound sodium chloride solution for liquid resuscitation，and the observation group was treated with sodium bicarbonate Ringer’s solution combined with lactic acid for targeted resuscitation．The changes in SvO₂，MAP，CI，HR，as well as changes in blood lactate，pH，Na⁺ ，Cl^- ，and HCO₃^- levels were compared between two groups of patients before and 24 hours after resuscitation．The time for symptom disappearance，consciousness recovery，mechanical ventilation，and ICU hospitalization were compared between the two groups of patients，as well as total length of hospital stay，poor prognosis，and incidence of complications．Results  That the SvO₂，MAP，and CI were elevated in both groups after resuscitation，and of the observation group （SvO₂［73.62±6.24］%，MAP［75.26±11.42］mmHg，CI［3.62±0.66］min/m² ）was  higher than that of the control group （［66.85±8.32］%，［68.51±8.37］mmHg，［3.16±0.35］min/m² ），the HR was decreased in all cases，the observation group（113.26±12.37）times/min was lower than the control group（122.62±12.73）times/min，the difference was statistically significant（t=4.117，P＜0.001；t=3.015，P=0.003；t=3.894，P＜0.001；t=3.335，P＜0.001）．After resuscitation，both groups blood lactate and Cl^-  were decased，pH value，Na⁺ ，and HCO₃^- increased，and the observation group blood lactate（1.46±0.52）mmol/L was lower than the control group（2.25±0.32）mmol/L，the difference was statistically significant（t=8.183，P＜0.001）．But the comparison of pH value，Na⁺ ，Cl^- ，and HCO₃^- levels between the two groups was not different（P＞0.05）．Time of disappearance（2.34±0.58）d，time of consciousness（1.15±0.27）d，time of mechanical ventilation（5.82±1.08）d，length of ICU stay（11.85±2.28）d and total length of stay（［23.15±4.26］d，［3.54±0.72］d，［2.95±0.34］d，［10.35±2.12］d，［15.12±3.23］d，［27.24±6.37］d），the difference was statistically significant（t=8.209，P＜0.001，t=26.221，P＜0.001，t=12.042，P＜0.001；t=5.231，P＜0.001；t=3.376，P＜0.001）．The incidence of multiple organ dysfunction syndrome，pulmonary edema，cerebral edema，reshock，and death in the observation group was significantly lower than that in the control group（7.50% vs 32.50%；χ ² =7.810，P=0.005，P＜0.05）．Conclusions  The combination of sodium bicarbonate Ringer’s solution and lactate targeted  resuscitation can improve the vital signs of septic shock patients，reduce lactate levels，significantly improve patient prognosis，shorten hospital stay，and assist in reducing the incidence of complications and mortality．