碳酸氢钠在感染性休克致低灌注性乳酸酸中毒时的分阶段应用  

The use of sodium bicarbonate in stages in treating hypoperfusion induced lactic acidemia in septic shock

作　　者：陈小枫[1] 叶纪录[1] 朱志云[1] 

机构地区：[1]扬州大学医学院附属泰州市人民医院ICU,江苏225300

出　　处：《中华危重病急救医学》2013年第1期24-27,共4页Chinese Critical Care Medicine

基　　金：江苏省科技支撑计划项目（BE2009611）

摘　　要：目的探讨分阶段应用碳酸氢钠对感染性休克致低灌注性乳酸酸中毒患者的效果。方法采用前瞻性随机对照双盲研究，将2006年4月至2010年4月本院65例感染性休克致低灌注性乳酸酸中毒患者按随机数字表法分为碳酸氢钠分阶段治疗组（35例）和对照组（30例）。两组均行早期目标导向治疗（EGDT），分阶段治疗组先静脉滴注（静滴）碳酸氢钠使pH值≥7．15，6h后再次静滴碳酸氢钠使pH值≥7．25；对照组静滴碳酸氢钠使pH值≥7．15。观察两组患者衰竭器官数、机械通气时间、最高序贯器官衰竭评分（s0FA）、SOFA评分差值、住重症监护病房（ICU）天数、住院天数、ICU病死率；分别于入院0h、8h测定患者血气分析和血流动力学指标。结果与对照组比较，分阶段治疗组衰竭器官数（个）、机械通气时间（d）、最高SOFA评分（分）、SOFA评分差值（分）、住ICU天数（d）、住院天数（d）及ICU病死率均明显降低（衰竭器官数：2．68±0．79比3．28±0．80，机械通气时间：10．32±2．26比13．80±2．56，最高SOFA评分：11．01±2．26比13．11±2．26，SOFA评分差值：1．71±1．25比3．43±1．27，住ICU天数：14．0±3．6比20．0±3．7，住院天数：28．3±12．9比41．9±13．2，ICU病死率：34．28％比60．00％，P〈0．05或P〈0．01）。两组入院0h时血气分析和血流动力学指标均无差异；8h时均有改善，与对照组比较，分阶段治疗组血乳酸（Lac，mmol／L）明显降低（1．50±1．08比2．93±1．09），pH值、混合静脉血氧饱和度（SvO2）、氧摄取率（O2ER）、心排血指数（CI，ml·s-1·m-2）、氧供（DO2，ml·min-1·m-2）明显升高（pH值：7．29±0．05比7．20±0．05，SvO2：0．75±0．18比0．66±0．17，02ER：0．32±0．06比0．25±0．06，CI：113．36±13．34比83．35±13．34，D02：840±170比630±171，均P〈0．01）。结论感染性休克致低灌�Objective To explore the use of sodium bicarbonate in stages in treating hypoperfusion induced lactic acidemia due to septic shock. Methods In this prospective randomized, double-blind, controlled clinical trial, a total of 65 patients of hypoperfusion induced lactic acidemia due to septic shock admitted between April 2006 and April 2010 were assigned to two groups. Thirty-five patients of ＂stage＂ group sodium bicarbonate was used in two stages： in first stage sodium bicarbonate was given by venous drip until pH ≥7.15, and in second stage sodium bicarbonate was given by intravenous drip till pH ≥7.25 after 6 hours. Thirty patients in control group intravenous drip of sodium bicarbonate was used till pH ≥7.15. Early goal-directed therapy （EGDT） was used in the first 6 hours of fluid resuscitation. The number of dysfunction organ, time of mechanical ventilation, maximum sequential organ failure assessment （SOFA） score, delta SOFA score, durations of stay in intensive care unit （ICU） and in hospital, and morality were recorded in two groups. Blood gas analysis and index of hemodynamics were monitored at 0 hour and 8 hours in both groups. Results Compared with control group, ＂stage＂ group was associated with a lower number of dysfunction organ, time of mechanical ventilation （days）, maximum SOFA score, delta SOFA score, durations of stay in ICU （days） and in hospital （days）, and mortality （number of dysfunction organ： 2.68 ± 0.79 vs. 3.28±0.80, time of mechanical ventilation： 10.32 ± 2.26 vs. 13.80 ± 2.56, maximum SOFA score： 11.01 ±2.26 vs. 13.11 ± 2.26, delta SOFA score： 1.71 ± 1.25 vs. 3.43 ±1.27, duration of stay in ICU： 14.0 ±3.6 vs. 20.0 ±3.7, duration of stay in hospital： 28.3 ± 12.9 vs. 41.9 ± 13.2, mortality： 34.28% vs. 60.00%, P〈0.05 or P〈0.01）. There were no significant differences in blood gas analysis and index of hemodynamics at 0 hour, and they were improved at 8 hours. Compared with control group, in ＂stage＂ group, lactic ac

关 键 词：碳酸氢钠 感染性休克 乳酸酸中毒 早期目标导向治疗 多器官功能障碍综合征 病死率 

分 类 号：R631.4[医药卫生—外科学]