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目的:调查常熟地区重症监护病房对脓毒性休克治疗指南的依从性以及患者的预后情况。方法:本研究为多中心、回顾性研究，筛选2014年1月至2017年10月入住常熟地区3家医院重症监护病房的患者，入选患者符合2016年脓毒性休克的诊断标准，排除年龄小于18岁、妊娠、中途放弃治疗、入院后6 h内死亡以及已进入其他有关脓毒性休克干预治疗研究的患者。记录其基本情况，既往史，入院时情况，1 h、3 h及6 h集束化治疗（Bundle）的完成情况以及预后。根据患者存活与否分为两组，比较两组Bundle指标完成情况，采用多因素Logistic回归分析影响预后的因素，并采用Kaplan-Meier方法绘制生存曲线。结果:3家医院共207例患者纳入研究，1 h Bundle完成率为27.1%，其中乳酸测定完成率81.2%，使用抗生素前血培养留取完成率72.5%，使用广谱抗生素完成率48.4%，液体复苏完成率74.4%，使用升压药维持平均动脉压≥65 mmHg（1 mmHg=0.133 kPa）完成率86.0%；3 h Bundle完成率为67.6%，其中乳酸测定完成率97.1%，使用抗生素前血培养留取完成率84.5%，使用广谱抗生素完成率97.1%，液体复苏完成率76.8%；6 h Bundle完成率为30.4%，其中平均动脉压达标完成率98.1%，重新评估容量状态（至少两项指标）完成率48.3%，中心静脉压达标完成率42.5%，中心静脉血氧饱和度（ScvOn 2）达标完成率10.6%，床边超声完成率48.8%，抬腿及补液治疗完成率42.5%，乳酸升高重新评估完成率55.1%。3 h及6 h Bundle总完成率为27.1%。三家医院的完成情况无明显差别。脓毒性休克患者总病死率为58.9%，住ICU时间为10 d（5，23） d，住院时间为14 d（6，26） d。单因素分析示抗生素使用时间，中心静脉压达标、床旁超声、抬腿补液试验，乳酸升高后重新评估以及6 h Bundle完成、3 h及6 h均Bundle完成、APACHEⅡ评分与患者的预后相关（n P=0.005，0.001，0.001，0.002，均n P<0.01），对上述指标进行Logistic回归分析显示中心静脉压达标（n OR=23.236，n P=0.001）、抬腿补液试验（n OR=0.102，n P=0.012），乳酸升高后重新评估（n OR=0.197，n P=0.001）及APACHEⅡ评分（n OR=1.103，n P<0.01）为患者预后的影响因素。28 d生存曲线显示6 h Bundle完成可降低病死率（Log Rank n χ2=8.944，n P=0.003）。n 结论:常熟地区对于脓毒症性休克治疗指南的依从性并不高，而依从性与预后密切相关，需要加强改进措施，提高指南的依从性。“,”Objective:To investigate the rate of compliance with sepsis Bundle and outcomes in patients with septic shock in intensive care units (ICU) in Changshu area.Methods:A multi-center retrospective study was conducted on patients who were diagnosed as septic shock in ICU of three hospitals in Changshu area from January 2014 to October 2017. Patients who were diagnosed as septic shock meeting the 2016 diagnostic criteria were enrolled. The exclusion criteria were paients younger than 18 years, pregnancy, death within 6 h of admission, halfway abandoned treatment, and those who had entered other studies on septic shock intervention. Clinical characteristics, past history, situation on admission, Bundle completion at 1 h, 3 h and 6 h, and prognosis were recorded. Patients were divided into the survival group and death groups according to whether they survived or not. The differences of completion of Bundle indicators between the two groups were compared. The independent risk factors of prognosis were analyzed by Logistic regression analysis, and the survival curve was plotted by Kaplan-Meier method.Results:Totally 207 patients from 3 hospitals were enrolled in this study. The complition rate of 1 h Bundle was 27.1%, of which the completion rate of serum lactate determination was 81.2%, the completion rate of blood culture before antibiotic administration was 72.5%, the completion rate of broad-spectrum antibiotic administration was 48.4%, the completion rate of fluid resuscitation was 74.4%, and the completion rate of vasopressors to maintain MAP≥65 mmHg was 86.0%; the completion rate of 3 h Bundle was 67.6%, of which the completion rate of serum lactate determination was 97.1%, the completion rate of blood culture before antibiotic administration was 84.5%, the completion rate of broad-spectrum antibiotic administration was 97.1%, and the completion rate of fluid resuscitation was 76.8%; the completion rate of 6 h Bundle was 30.4%, of which the completion rate of vasopressors to maintain MAP≥65 mmHg was 98.1%, the completion rate of reassessed volume stasis (at least two indexes) was 48.3%, the completion rate of central venous pressure (CVP) was 42.5%, the completion rate of ScvOn 2 was 10.6%, the completion rate of bedside ultrasound was 48.8%, the completion rate of passive leg raising and rehydration therapy was 42.5%, and the completion rate of re-evaluation of lactate was 55.1%. The total Bundle completion rate at 3 h and 6 h was 27.1%. There was no significant difference in the completion of the three hospitals. The mortality of patients with septic shock was 58.9%, length of stay in the ICU was 10 d (5, 23) d, and length of hospital stay was 14 d (6, 26) d. Univariate analysis showed that antibiotic use time, CVP, bedside ultrasound, passive leg raising and rehydration experiments, re-evaluation after elevated lactate, 6 h Bundle completion, total Bundle completion at 3 and 6 h, and APACHE Ⅱ score were associated with the prognosis (all n P<0.01). Logistic regression analysis showed that CVP (n OR=23.236, n P=0.001), passive leg raising and rehydration experiments (n OR=0.102, n P=0.012), re-evaluation after elevated lactate (n OR=0.197, n P=0.001) and APACHEⅡ score (n OR=1.103, n P<0.01) were risk factors of the prognosis. Kaplan-Meier analysis showed that the 28 d survival rate was significantly higher if 6 h Bundle was completed (Log Rank χ n 2=8.944, n P=0.003).n Conclusions:The compliance with sepsis Bundle is not high in Changshu area, and the compliance is closely related to the prognosis, so it needs to improve compliance with the guidelines.