液体复苏对感染性休克患者内稳态及APACHE Ⅱ评分的影响及其意义  

Effects of Fluid Resuscitation on Homeostasis and Acute Physiology and Chronic Health EvaluationsⅡof Patients with Septic Shock

作　　者：刘少华 左祥荣[1,2] 阙军 曹权[1,2] 

机构地区：[1]南京医科大学第一附属医院 [2]江苏省人民医院重症医学科,江苏南京210029

出　　处：《中国普外基础与临床杂志》2013年第5期508-511,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的观察液体复苏对感染性休克患者血气分析、酸碱平衡、电解质、急性生理和慢性健康状况评估Ⅱ(APACHEⅡ)评分的影响,进而分析它们与复苏液体总量的相关性,并探讨其临床意义。方法 24h达标(中心静脉压8～12mmHg、平均动脉血压≥65mmHg)复苏治疗21例符合本研究入选标准的感染性休克患者,前瞻性自身比较复苏治疗前及复苏治疗24h后血气分析、酸碱平衡、电解质及APACHEⅡ评分,直线回归分析电解质、酸碱、血气分析指标及APACHEⅡ评分与复苏液体总量的相关性。结果 21例感染性休克患者24h内复苏液体总量为(7775±1735)mL(5320～11028mL),复苏达标时间为(18.09±4.57)h。复苏治疗24h后血Na+(mmol/L)和Cl-(mmol/L)均较治疗前明显升高(Na+:138.71±5.67比135.62±7.23,P=0.024;Cl-:109.10±4.90比101.67±8.59,P=0.000);血pH值、红细胞比容(Hct,%)、阴离子隙(AG,mmol/L)、乳酸(mmol/L)及APACHEⅡ评分(分)均较治疗前明显下降(pH:7.31±0.05比7.37±0.06,P=0.000;Hct:28.48±2.56比32.76±9.19,P=0.049;AG:8.33±3.45比14.17±8.83,P=0.004;乳酸:1.66±0.89比2.96±1.23,P=0.001;APACHEⅡ评分:10.90±3.73比17.24±4.06,P=0.000)。血Cl-水平与复苏液体总量呈正相关(r=0.717,P<0.01)、其余电解质、酸碱、血气分析指标及APACHEⅡ评分与复苏液体总量无相关性(P>0.05)。结论感染性休克患者应制定适宜的液体复苏目标,并监测内环境的变化,尽可能控制晶体液输入量及不良内环境影响。复苏治疗减轻病情与输注液体总量无明显相关。Objective To evaluate the effects and the clinical significances of liquid resuscitation on blood gas analysis,acid-base balance,electrolytes,acute physiology and chronic health evaluationsⅡ（APACHEⅡ） score of patients with septic shock,and then to analyze the relations between serum chlorine（Cl-） level and APACHEⅡscore and the volume of liquid resuscitation.Methods According to the target of resuscitation（centre venous pressure 8-12？mm Hg and mean arterial pressure≥65？mm Hg）,21 patients with septic shock received enough fluid for resuscitation during 24？h.The results of blood gas analysis,acid-base balance,electrolytes,and APACHE Ⅱ score were compared between pre-resuscitation and 24？h post-resuscitation by self-controlled prospective study.The relationships of the level of serum Cl-and APACHEⅡ score with the volume of liquid used in resuscitation were analyzed.Results The mean resuscitation duration was（18.09±4.57） h,and the volume of liquid during 24 h resuscitation was 5 320-11 028？mL with mean volume of（7 775±1 735） mL in 21 patients with septic shock.Serum sodium（Na＋,mmol/L） and Cl-？（mmol/L） levels of post-resuscitation were significant higher than those of pre-resuscitation（Na＋：138.71±5.67 versus 135.62±7.23,P=0.024;Cl-：109.10±4.90 versus 101.67±8.59,P=0.000）.Compared with the levels of pre-resuscitation,the blood pH value,hematocrit（Hct,%）,anion gap（AG,mmol/L）,lactic acid（mmol/L）,and APACHE Ⅱ score significantly decreased（pH：7.31±0.05 versus 7.37±0.06,P=0.000;Hct：28.48±2.56 versus 32.76± 9.19,P=0.049;AG：8.33±3.45 versus 14.17±8.83,P=0.004;lactic acid：1.66±0.89 versus 2.96±1.23,P= 0.001;APACHEⅡ：10.90±3.73 versus 17.24±4.06,P=0.000） after 24？h resuscitation.The correlation analysis showed that the level of serum Cl-was positively correlated with the volume of liquid used in resuscitation（r=0.717, P0.01）.However,there was no correlation between APACHEⅡscore and the volume of liquid used in res

关 键 词：液体复苏 感染性休克 内稳态 急性生理和慢性健康状况评估Ⅱ评分 

分 类 号：R459.7[医药卫生—急诊医学]