中心静脉-动脉二氧化碳分压差/动脉-中心静脉氧含量差在脓毒症休克患者复苏中的指导作用

目的评估中心静脉-动脉二氧化碳分压差/动脉-中心静脉氧含量差△PCO2/C(a-cv)O2]在脓毒症休克患者复苏中的指导价值。方法将入组的52例感染性休克患者随机分为治疗组(△PCO2/C(a-cv)O两组)和对照组(ScvO两组)。对照组患者根据拯救脓毒症休克指南予以液体复苏治疗,治疗组患者根据△PCO2/C(a-cv)O2进行液体复苏。采集所有入组患者入ICU时(T0)和复苏12,24 h后的循环代谢指标:心率(HR),平均动脉压(MAP)、心指数(CI)、动脉及中心静脉血乳酸水平(Lac);计算12、24 h时氧输送(DO2)、氧耗(VO2);记录患者24、48h的急性生理与慢性健康评分(APACHEⅡ);住ICU时间、总住院时间及28d死亡人数。结果两组治疗后HR、Lac下降,MAP、DO2、VO2、CI均升高,与治疗前相比差异有统计学意义(P<0.05);与对照组相比,治疗组患者治疗后CI、DO2、VO2升高,HRs Lac下降,差异有统计学意义(P<0.05);治疗后两组间MAP无明显变化(P>0.05)。两组患者治疗后APACHEⅡ评分下降,治疗组下降更明显,差异有统计学意义(P<0.05);治疗组患者住ICU时间及总住院时间短于对照组(P<0.05);治疗组住院及28 d病死率低于对照组,但差异无统计学意义(P>0.05)。结论利用△PCO2/C(a-cv)O2指导感染性休克患者液体复苏可改善患者组织灌注,改善患者病情,减少住院时间。

The clinical value of P(cv-a)C02/C(a-cv)02 ratio in guiding fluid resuscitation in patients with septic shock

Objective To evaluate the clinical value of P(cv-a)C02/C(a-cv)02 ratio in guiding fluid resuscitation in patients with septic shock.Methods A total of 52 cases of patients with septic shock were enrolled in this study.The patients were randomly divided into treatment group and control group,26 patients in each group.The patients in treatment group underwent the early liquid resuscitation treatment according to P(cv-a)C02/C(a-cv)02 ratio and the patients in control group underwent the early liquid resuscitation treatment according to Surviving sepsis campaign 2012.The following data were colleted:HR,MAP,CI,lactic acid(Lac),D02,VO2APACHEⅡscore,duration of ICU and hospital stay,mortality in hospital and 28 day were also recorded.Results After treatment of 12h,the patient's HR、Lac were decreased in treatment group(P<0.05),and after treatment of 12 h,the patient's Lac was decreased in control group(P<0.05);After treatment of 24h,the patient's HR was decreased n control group(P<0.05);After treatment of 12h,the patient's MAP、DO2、VO2、CI were were improved in both group(P<0.05),and compared with the control group,the indexes of D02、V02、CI improved significantly in treat-ment group(P<0.05),After treatment of 12 h,the patientrs Lac was lower in treatment group compared with the control group(P<0.05).After treatment of 24h,the patient's HR was lower in treatment group compared with the control group(P<0.05).The APACHEⅡwere improved after the treatment in two groups.After treatment of 24、48h,the levels of the above parameters were significantly improved in the treatment group compared with the control group,(P<0.05).The time of stay in ICU and hospital in treatment group were shorter than in control group(P<0.05).Conclusion Using A PCO2/C(a-cv)O2 to guide fluid resuscitation in patients with septic shock can significantly improve tissue perfusion in patients,correct tissue hypoxia,reduce patient ICU and hospital stay,and reduce septic shock patients rate.