液体复苏对严重脓毒症及脓毒性休克患者的治疗作用研究  

The therapeutic effects of fluid resuscitation in severe sepsis and septic shock

作　　者：苏群[1] 方强[1] 吴立峰[2] 严静[3] 

机构地区：[1]浙江大学医学院附属第一医院ICU,杭州310003 [2]浙江省余姚市人民医院ICU [3]浙江医院ICU

出　　处：《中华外科杂志》2006年第19期1336-1338,共3页Chinese Journal of Surgery

基　　金：浙江省医药卫生重点科技计划项目(2004ZD002)

摘　　要：目的评价液体复苏手段对严重脓毒症或脓毒性休克的治疗作用。方法通过液体复苏使20例严重脓毒症或脓毒性休克患者达到如下治疗目标:中心静脉压8～12 mm Hg(机械通气者12～15 mm Hg)、平均动脉压65～90 mm Hg、混合静脉血氧饱和度>70%。测定达标前后血流动力学、组织灌注、血管内皮细胞功能的变化。结果液体复苏达标后,肺动脉楔压明显升高(P<0.01),心指数及体循环阻力指数增加(P<0.01),肺循环阻力指数下降(P<0.01),左心室做功指数上升(P<0.01);组织灌注指标中动脉血乳酸(ABL)在复苏后下降(P<0.01),胃黏膜二氧化碳分压与动脉血二氧化碳分压差(Pg-aCO_2)在复苏后明显下降(P<0.01),血管内皮细胞功能中内皮素及血管性假血友病因子在液体复苏后下降(P<0.05)。结论液体复苏早期达标可改善严重脓毒症或脓毒性休克患者血流动力学和组织灌注并可减轻血管内皮细胞的损伤,是一种有效的治疗方式。Objective To evaluate the therapeutic effect of fluid resuscitation on severe sepsis and septic shock. Methods Twenty patients with severe sepsis and septic shock were given fluid resuscitation and got the following parameters in the ranges as follow： central venous pressure（CVP） 8 -12 mm Hg （for ventilation patient： 12- 15 mm Hg）, mean artery pressure（MAP） 65 -90 mm Hg, mixed venous oxygen saturation（ SmvO2 ） 〉 70%. Hemodynamics, tissue perfusion and vascular endothelial cell function were measured and compared before and after fluid resuscitation. Results Pulmonary arterial wedge pressure （PAWP）, cardiac index（CI） , left ventricular stroke work index（LVSWI） and systemic vascular resistance index（SVRI） increased significantly after reached the goal of fluid resuscitation （P 〈 0.01 ） whereas pulmonary vascular resistance index （PVRI） , lactate level in arterial blood and gastric-to-arterial carbon dioxide partial pressure gap （ Pg-aCO2 ） decreased significantly （ P 〈 0.01 ）, and the serum levels of endothelin（ET） and von Willebrand factor （vWF） were also decreased significantly after fluid resuscitation （P 〈 0. 05 ）. Conclusions Early goal-directed fluid resuscitation can improve hemodynamics, tissue perfusion and alleviate vascular endothelial cell injury in patients with severe sepsis and septic shock, it is an effective therapy for these patients.

关 键 词：脓毒症 休克 脓毒性 液体复苏 

分 类 号：R459.7[医药卫生—急诊医学]