感染性休克患者应用早期目标导向治疗对组织微循环及氧代谢的影响分析  

Effect of early goal directed therapy on tissue perfusion and oxygen metabolism in patients with septic shock

作　　者：林松梅 高玉明 周国庆 

机构地区：[1]山东省青岛市胶州中心医院急诊内科,266300 [2]山东省淄博市第一医院急诊科

出　　处：《中国医师进修杂志》2014年第22期55-58,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨早期目标导向治疗（EGDT）对感染性休克患者组织灌注、微循环和氧代谢的影响。方法选取早期感染性休克（〈24h）患者69例，按照EGDT流程对患者进行治疗，监测经皮氧分压（PtcO2）和经皮二氧化碳分压（PtcCO2），检测EGDT达标前后血流动力学、组织氧和舌下微循环变化，同时变量相关性采用Pearson相关分析。结果与治疗前相比，EGDT治疗后PtcO2[（78．1±30．8）mmHg（1mmHg=0．133kPa）比（62．8±24．1）mmHg]、组织氧合指数（PtcOJFiO2）[（141．7±78．3）mmHg比（110．8±60．5）mmHg]显著增加，PtcC02[（29．0±4．1）mmHg比（39．1±6．4）mmHg]和经皮．动脉二氧化碳分压差[（1．4±0．5）mmHg比（1．7±0．8）mmHg]显著降低，差异有统计学意义（P〈0．05）。PtcO2、PtcO2/FiO2、PtcCO2与中心静脉血氧饱和度、乳酸、氧输送、氧耗比较差异均无统计学意义（P〉0．05）。结论EGDT能改善感染性休克患者局部组织灌注和微循环，感染性休克EGDT达标前后全身组织灌注的指标可能不能反映局部组织灌注。Objective To observe the effect of early goal directed therapy （EGDT） on tissue perfusion,microcirculation and oxygen metabolism in patients with septic shock. Methods A prospective observational study was carried out in 69 patients with early septic shock within 24 hours. The eligible patients were treated with the standard procedure of EGDT. The partial pressure of transcutaneous oxygen （PtcO2） and transcutaneous carbon dioxide （PtcCO2） was monitored and the changes of hemodynamic data, tissue oxygen,microcirculation before and after reaching the criteria of EGDT were recorded. Results Compared with that before treatment,PtcO2,tissue oxygenation index （PtcO2/FiO2） after EGDT was increased [ （78.1 ± 30.8） mmHg （ 1 mmHg = 0.133 kPa） vs. （62.8 ± 24.1 ） mmHg and （141.7 ±78.3） mmHg vs. （110.8 ± 60.5） mmHg], PtcCO2 and percutaneous arterial carbon dioxide partial pressure difference was decreased [ （29.0± 4.1 ） mmHg vs. （39.1± 6.4） mmHg and （ 1.4 ±0.5 ） mmHg vs. （ 1.7 ±0.8 ） mmHg ], there was significant difference （P 〈 0.05 ）. There was no significant difference in PtcO2, PtcO2/FiO2, PtcCO2, central venous blood oxygen saturation, lactic acid, oxygen and oxygen consumption （P 〉 0.05 ）. Conclusion EGDT can improve local tissue perfusion and microcirculation in patients with septic shock, body tissue perfusion index before and after EGDT may not be able to reflect the local tissue perfusion.

关 键 词：微循环 感染性休克 早期目标导向治疗 组织灌注 氧代谢 

分 类 号：R459.7[医药卫生—急诊医学]