脓毒性休克患者中心静脉-动脉二氧化碳分压差持续增高与预后关系研究  

Persistently High Central Venous-to-arterial Carbon Dioxide Differences in Septic Shock Patients and the Outcomes

作　　者：祖国亮[1] 朱宏泉[1] 许庆林[1] 尹康[1] 欧阳松茂[1] 刘晓峰[1] 

机构地区：[1]赣南医学院第一附属医院重症医学科,江西赣州341000

出　　处：《赣南医学院学报》2015年第6期891-894,共4页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:探讨中心静脉-动脉二氧化碳分压差[P(cv-a)CO2]增高的脓毒性休克患者治疗后的转归与预后。方法:回顾性分析我院重症医学病房收治的56例脓毒性休克并P(cv-a)CO2≥6 mm Hg患者的数据,按照治疗6 h后P(cv-a)CO2是否仍大于6 mm Hg分为两组,即P(cv-a)CO2持续高组(HH组,29例)和P(cv-a)CO2下降组(HL组,27例),比较两组患者基线(T0)及治疗6 h(T6)的心率、MAP、乳酸、SCVO2、CVP、氧分压、氧合指数。比较两组患者6 h及24 h乳酸清除率,第3天的SOFA分值、28天病死率。结果:两组治疗6 h后MAP差异有统计学意义,HL组较高(P<0.05),HL组在T6乳酸清除率高于HH组,差异具有显著性(P<0.001),HL组在24 h乳酸清除率高于HH组,差异具有显著性(P<0.001)。第3天SOFA分值HL分值低于HH组,差异具有统计学意义(P<0.001)。HL组28天病死率较HH组显著降低(62%比26%,χ2=7.28,P<0.01)。结论:脓毒性休克患者早期P(cv-a)CO2对复苏的反应如何对预后具有重要的判断价值,持续处于高水平的患者预后较差。Objective： To assess the outcomes of the septic shock patients with persistently high central venous-to-arterial carbon dioxide differences. Methods： Retrospective study was conducted for 56 septic patients with P（ev-a） CO2 ≥ 6 mmHg. They were divided into two groups according to P （cv-a） CO2≥ 6 mmHg or not after 6 hours resuscitation： P（cv-a） CO2 persistently high group（ HH,29）, P（cv-a） CO2 decreased group（HL,27）. The heart rate, MAP, lactate, ScvO2, CVP, PO2, POJFiO2 at base line （TO） and after 6 hours resuscitation （T6） of the two groups were compared. The clearance of lactate from TO to T6 and from TO to 24 hours was compared between the two groups. SOFA at day-3 and the 28 days mortality were compared between the two groups. Results： After 6 hours resuscitation, there was statistical difference in MAP between the two groups, HL group was relatively higher （ P 〈 0.05 ） ; The clearance of lactate from TO to T6 （P 〈 0.001 ）and from TO to 24 hours （P 〈 0.001 ） in HL group patients was significant higher compared with HH group patients. Patients in HH group had significant higher SOFA scores at day-3 （ P 〈 0. 001 ） and higher mortality rates at day-28（62% vs. 26% , X2 =7.28, P 〈0.01 ） compared with HL group patients. Conclusion： For septic shock patients, P（cv-a） CO2 change after early resuscitation might be an indicator of prognosis. Persistently high P（ev-a） CO2 means worse outcomes.

关 键 词：脓毒性休克 中心静脉-动脉二氧化碳分压差 预后 

分 类 号：R441.9[医药卫生—诊断学]