静动脉二氧化碳分压差联合中心静脉血氧饱和度检测在脓毒性休克患者液体复苏中的指导作用  

Central Venous-arterial Carbon Dioxide Difference Combined with Central Venous Oxygen Saturation in Detection of Fluid Resuscitation of Patients with Septic Shock

作　　者：连晓芳[1] 阎书彩[1] 王贵法[1] 王卉[1] 顾晓静[1] 吴志红[2] 刘晓娜[3] 

机构地区：[1]石家庄市第一医院重症医学二科,石家庄050011 [2]石家庄市第一医院心内科,石家庄050011 [3]石家庄市第一医院神经内二科,石家庄050011

出　　处：《解放军医药杂志》2015年第9期86-90,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：石家庄市科学技术研究与发展项目(121461653)

摘　　要：目的探讨静动脉二氧化碳分压差(central venous-to-arterial carbon dioxide difference,Pcv-a CO2)在脓毒性休克患者预后判断中的价值,及其联合中心静脉血氧饱和度(central venous oxygen saturation,Scv O2)检测在该类患者液体复苏中的指导作用。方法选取2011年3月—2013年12月我院重症医学二科住院的脓毒性休克患者98例,根据早期目标指导性治疗原则进行液体复苏,观察所有患者液体复苏前、复苏6 h时心率、平均动脉压(MAP)、中心静脉压(CVP)、Scv O2、乳酸、Pcv-a CO2水平。治疗28 d后根据患者是否存活分为死亡组和存活组,比较两组复苏6 h时急性生理学与慢性健康评定标准Ⅱ(APACHEⅡ)评分、乳酸清除率、Scv O2、Pcv-a CO2水平。根据复苏6 h时Pcv-a CO2是否≥6 mm Hg分为高Pcv-a CO2组和低Pcv-a CO2组,比较两组APACHEⅡ评分、6 h乳酸清除率、Scv O2及病死率。分析复苏6 h时Scv O2≥0.70的患者Pcv-a CO2与乳酸清除率的相关性。结果与液体复苏前比较,复苏6 h时98例患者MAP、Scv O2增高,乳酸、Pcv-a CO2降低,差异有统计学意义(P<0.05或P<0.01)。复苏6 h时,死亡组APACHEⅡ评分、Pcv-a CO2明显高于存活组,乳酸清除率、Scv O2低于存活组,差异均有统计学意义(P<0.05或P<0.01)。复苏6 h时高Pcv-a CO2组病死率明显高于低Pcv-a CO2组(P<0.05),乳酸清除率明显低于低Pcv-a CO2组(P<0.05或P<0.01)。复苏6 h时Scv O2≥0.70的患者中Pcv-a CO2≥6 mm Hg者乳酸清除率低于Pcv-a CO2<6 mm Hg者乳酸清除率的差异有统计学意义(t=1.798,P=0.049),且二者呈明显负相关(r=-0.846,P=0.000)。结论 Pcv-a CO2可作为评估脓毒性休克患者预后的指标,Pcv-a CO2联合Scv O2检测在脓毒性休克患者液体复苏中具有重要的指导作用,可避免Scv O2假性正常。Objective To investigate the value of central venous-arterial carbon dioxide difference （ Pcv-aCO2 ） in evaluating the prognosis and the guiding effect on fluid resuscitation by Pcv-aCO2 combined with central venous oxygen saturation （ ScvO2 ） in detection of patients with septic shock. Methods A total of 98 patients with septic shock admitted during March 2011 to December 2013 underwent fluid resuscitation according to early goal directed therapy （ EGDT ） principle. The levels of heart rate （ HR） , mean arterial pressure （ MAP） , central venous pressure （ CVP） , ScvO2 , lac-tic acid and Pcv-aCO2 of all patients before and 6 h after the fluid resuscitation were detected. The patients were divided into survival group and death group after treatment for 28 d, and the acute physiology and chronic health evaluation II （ A-PACHE II） score, lactate clearance rate and ScvO2 , and Pcv-aCO2 levels at 6 h after the resuscitation in the two groups were compared. The patients were again divided into high Pcv-aCO2 group （ Pcv-aCO2≥6 mmHg） and low Pcv-aCO2 group （ Pcv-aCO2 〈6 mmHg） according to Pcv-aCO2 value at 6 h after the resuscitation, and APACHE II score, lactate clearance rate, ScvO2 and fatality rate in the two groups were also compared. The correlation between Pcv-aCO2 value and lactate clearance rate was analyzed for patients whose ScvO2 value was greater than or equal to 0. 70 at 6 h after the resus-citation. Results Compared with those before liquid resuscitation, at 6 h after the resuscitation, MAP and ScvO2 values were increased, while the levels of lactic acid and Pcv-aCO2 were decreased in the 98 patients, and the differences were statistically significant （P〈0. 05 or P〈0. 01）. At 6 h after the resuscitation, in the death group, APACHE II score and Pcv-aCO2 value were significantly higher, while the lactate clearance rate and ScvO2 value were significantly lower than those in the survival group, and the differences were statistically significant （P〈0. 05 or P�

关 键 词：休克 脓毒性 静动脉二氧化碳分压差 中心静脉血氧饱和度 乳酸清除率 复苏术 

分 类 号：R631.4[医药卫生—外科学]