FloTrac/Vigileo监测液体复苏对外科脓毒性休克患者氧代谢的影响  

The effects of fluid resuscitation with FloTrac/Vigileo monitoring on oxygen metabolism for surgical septic shock

作　　者：崔曼丽[1] 吴明[1] 曾晶晶[1] 李明利[1] 何云[1] 李颖[1] 冯永文[1] 

机构地区：[1]深圳大学第一附属医院（深圳市第二人民医院）重症医学科,广东518035

出　　处：《中国急救医学》2011年第11期968-971,共4页Chinese Journal of Critical Care Medicine

基　　金：广东省深圳市科技计划项目（No.200902055）

摘　　要：目的 观察FloTrac/Vigileo监测液体复苏对外科脓毒性休克患者氧代谢的影响.方法 选择2009-07~2011-07外科脓毒性休克需机械通气患者30例,随机分为对照组和观察组,每组15例.对照组采用传统的液体复苏,维持MAP 65~90 mm Hg,CVP 8~12 mm Hg,尿量＞0.5 Ml/（kg·h）.观察组采用FloTrac/Vigileo持续监测,维持心脏指数（CI）2.5~4.0 L/（min·m2）,每搏量（SV）60~100 Ml/次,每搏变异度（SVV）〈13%,中心静脉血氧饱和度（ScvO2）〉70%,观察早期液体复苏对两组患者氧代谢的影响.结果 ①液体复苏均能提高CVP、MAP及尿量（P〈0.05或P〈0.01）;②液体复苏后两组在6、12、24 h氧输送（DO2）显著增加（P〈0.01）,氧消耗（VO2）也有一定程度的增加,但无统计学意义（P〉0.05）,氧摄取率（ERO2）显著降低（P〈0.05）;③液体复苏均能使对照组和观察组ScvO2升高,并使ScvO2〉70%的时点分别在12 h、6 h,两组比较差异无统计学意义（P〉0.05）;④观察组在6、12、24 h血乳酸及血乳酸清除率显著低于对照组（P〈0.01）.结论 与传统液体复苏比较,FloTrac/Vigileo通过实时监测CI、SV、SVV、ScvO2,提高DO2,降低ERO2,增加血乳酸清除率,改善组织灌注.Objective To observe the effects of fluid resuscitation by using FloTrac/Vigileo monitor on oxygen metabolism for surgical septic shock patients. Methods Thirty surgical septic shock patients ,who needed ventilator to keep breathing from July 2009 to July 2011, were enrolled in the study and randomly divided into two groups： control group and observation group （fifteen patients per group） . MAP was kept at 65 - 90 mm Hg, CVP at 8 - 12 mm Hg, but urine output 〉 0.5 mL（ kg · h） in control group with traditional fluid resuscitation method; Cardiac index （CI） was kept at 2.5 - 4.0 L/（ min · m2 ）, stroke volume （SV） at 60 - 100 mL/beat, stroke volume variability （SVV） 〈 13 %, and central venous oxygen saturation （ ScvO2 ） 〉 70% in the observation group by using FloTrac/Vigileo. The effects of fluid resuscitation on oxygen metabolisms were analysed in two groups. Results （1）Fluid resuscitation could increase CVP, MAP and urine output in both groups （P 〈 0.05 or P 〈 0.01 ） ; （2）After the fluid resuscitation, oxygen delivery （DO2 ） had been apparently increased for both groups at 6,12 and 24 h （P 〈0.01 ）,and the consumption of oxygen （VO2 ） had also increased to some extent, however there was no statistical significance（ P 〉 0.05 ）. Meanwhile the oxygen extraction rate （ ERO2 ） had decreased （ P 〈 0.05 ） ; （3）After fluid resuscitation, the ScvO2 had increased in both groups, and ScvO2 〉 70% was at 12 and 6 h in control group and observation group respectively, and there was no statistical significanceat 12 h （P 〉 0.05 ）; （4）Blood lactate and blood lactate clearance rate was significantly lower in observation group at 6, 12 and 24 h than in the control group, the differences had statistical significance in each group （ P 〈 0.01 ）. Conclusion Compared with traditional method, fluid resuscitation with FloTrac/Vigileo could increase DO2, decrease ERO2 , raise the blood lactate clearance rate and improve the tissue peffus

关 键 词：FLOTRAC/VIGILEO 脓毒性休克 液体复苏 血乳酸清除率 中心静脉血氧饱和度 

分 类 号：R605.971[医药卫生—急诊医学]