中心静动脉血二氧化碳分压差联合早期乳酸清除率对感染性休克患者预后的判断价值  

Prognostic value of central venous - to - arterial carbon dioxide difference and early lactate clearance rate in septic shock

作　　者：杨新静[1] 金钧[1] 黄坚[1] 郭强[1] 王俊[1] 付建红[1] 黄芳[1] 徐华[1] 

机构地区：[1]苏州大学附属第一医院重症医学科,江苏苏州215006

出　　处：《中国急救医学》2015年第7期589-592,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨中心静动脉血二氧化碳分压差（Pcv—aCO2）和早期乳酸清除率在评估感染性休克患者预后中的临床意义。方法选取2010-01—2013—10收住我院重症医学科的82例经早期目标导向治疗（EGDT）达标的感染性休克患者进行前瞻性观察研究，记录入院6hPcv—aCO2及患者入院后第-个24h急性生理学和慢性健康状况评分系统Ⅱ（acute physiology and chronic health evaluationⅡ，APACHEⅡ）评分和全身性感染相关性器官衰竭（SOFA）评分；并记录入院时、人院6h、入院24h动脉血乳酸，计算早期乳酸清除率；以入院6hPcv—aCO2高低分为两组：A组（Pcv—aCO2〈6mmHg）和B组（Pcv—aCO2≥6mmHg），比较两组患者乳酸清除率、SOFA评分及病死率。以6h乳酸清除率高低分为两组：c组（乳酸清除率≤10％）和D组（乳酸清除率〉10％），比较两组患者的28天病死率。根据28天病程转归分为死亡组（32例）和存活组（50例），比较两组患者不同时间动脉血乳酸浓度、APACHEⅡ评分。结果B组较A组乳酸清除率低，SOFA评分及病死率高，入院6hPcv—aCO2与6h乳酸清除率存在负相关（r=-0．324，P=0．003）。D组病死率低于C组（P〈0．05）。存活组APACHEⅡ评分较死亡组高，而入院时、6h、24h动脉血乳酸浓度均低于死亡组（P〈0．05）。结论6hPcv—aC02和6h乳酸清除率可作为判断感染性休克患者预后的指标。Objective To investigate the clinical value of central venous - to - arterial carbon dioxide diference （Pcv - aCO2 ） and early lactate clearance rate in evaluating the prognosis of patients with septic shock. Methods Eighty - two consecutive septic shock patients in Intensive Care Unit （ICU） underwent early goal - directed therapy （EGDT） were studied prospectively from January 2010 to October 2013. 6 h Pcv- aCO2, the APACHE Ⅱ score and SOFA score were evaluated. Arterial blood lactate level were measured at 0, 6, 24 h after inclusion and calculated lactate clearance rate. Based on 6 h Pcv - aCO2（6 mm Hg as limit）, the patients were divided into A group （ 〈6 mm Hg） and B group （ ≥6 mm Hg）, which compared by SOFA score, lactate clearance rate and mortality. According to 6 h lactate clearance rate, the patients were divided C group （ ≤ 10% ） and D group （ 〉 10% ）. The two groups of patients were compared by 28 - day mortality. According to the 28 - day disease outcome, the patients were divided into death group （ n = 32） and survival group （ n = 50）, which were compared by APACHE Ⅱ score and lactate level. Results The mortality and SOFA score of B group were higher than A group （P 〈 0.05）, and lactate clearance rate of B group was lower than A group （ P 〈 0.05 ）. The level of 6 h Pcv - aCO2 was negatively correlated with the 6 h lactate clearance rate （ r = - 0. 324, P =0.003）. There was significant difference in mortality between C and D group （ P 〈 0.05 ）. Significant differences of the lactate at 0, 6, 24 h and were found between death group and survival group （P 〈 0. 05）. The APACHE Ⅱ score of death group was higher than the survival group （ P 〈 0. 05 ）. Conclusion 6 h Pcv - aCO2 and 6 h lactate clearance rate may serve as a useful index for predicting the prognosis of patients with septic shock.

关 键 词：中心静动脉血二氧化碳分压差(Pcv—aCO2) 乳酸 乳酸清除率 中心静脉氧饱和度(ScvO2) 感染性休克 早期目标导向治疗(EGDT) 预后 

分 类 号：R641[医药卫生—外科学]