重症脓毒症及脓毒性休克患者复苏中P(cv-a)CO2／C(a-v)O2变化与P(cv-a)CO2变化的临床价值比较  

Comparison of the Clinical Value of Central Venous-to-Arterial CO_2 Difference/arterial-central Venous O_2 Difference Ratio and Central Venous-to-arterial CO_2 Difference in Guiding Fluid Resuscitation of Patients with Severe Sepsis and Septic Shock

作　　者：姜智敏[1] 吕丹[1] 张柯基[1] 朱长清[1] 

机构地区：[1]上海交通大学医学院附属仁济医院急诊科,上海200127

出　　处：《现代生物医学进展》2016年第34期6762-6765,共4页Progress in Modern Biomedicine

基　　金：上海市科学技术委员会科技攻关计划项目(13142201002)

摘　　要：目的:探讨P(cv-a)CO_2/C(a-v)O_2变化与P(cv-a)CO_2变化在重症脓毒症及脓毒性休克患者液体复苏中的临床价值,并比较二者与乳酸清除率的相关性。方法:入选上海仁济医院急诊监护室收治的合并高乳酸血症(≥4 mmol/L)的重症脓毒症或脓毒症休克患者60例,按脓毒症指南早期目标导向治疗(EGDT)进行复苏,检测复苏前(0 h)和复苏后(6 h)、(24 h)的动脉血、上腔静脉血气以及乳酸浓度,分别计算各时间点的P(cv-a)CO_2/C(a-cv)O_2值,P(cv-a)CO_2值,分析比较与各时间点血乳酸水平的相关性。分别计算复苏前后的P(cv-a)CO_2/C(a-cv)O_2值和P(cv-a)CO_2值的变化值,比较与相应时间点乳酸清除率的相关性。结果:复苏前和复苏后的P(cv-a)CO_2/C(a-cv)O_2值以及P(cv-a)CO_2值与血乳酸浓度明显相关,r分别为0.873,0.644(0 h);0.885,0.585(6h);0.858,0.669(24 h),(P均<0.01),且前者相关性优于后者。复苏前后的P(cv-a)CO_2/C(a-cv)O_2值的变化和P(cv-a)CO_2值的变化都与相应时间点的乳酸清除率明显相关,r分别为0.874,0.635(6h);0.807,0.530(24h);并且前者的相关性优于后者(均P<0.05)。结论:P(cv-a)CO_2/C(a-cv)O_2比P(cv-a)CO_2能更好的提示液体复苏过程中组织缺氧情况的变化。Objective： To discuss the clinical value ofP （cv-a） CO2/C（a-v）O2 ratio and P（cv-a） CO2 in guiding fluid resuscitation in patients with severe sepsis and septic shock, and analyze the relationship between P （cv-a）CO：/C（a-v）O2 ratio, P（cv-a）CO2 and the rate of lactate clearance. Methods： 60 patients whose blood lactate-〉 4 mmol/L with severe sepsis and septic shock were enrolled in this study in emergency intensive care unit of Renji hospital. The patient underwent fluid resuscitation through early goal directed therapy（EDGT）. The material blood gas, the superior vena cava blood gas and the blood lactate were detected before resuscitation（0h）, and at 6h,24h after resuscitation. P （cv-a） CO2/C（a-v） 02 ratio, P（cv-a） COs were calculated respectively at each time point and were analyzed the relationship with blood lactate. The changes between P （cv-a） CO2/C （a-v） 02 ratio, P （cv-a） COs before and after resuscitation were calculated respectively, and the relationship of P （cv-a） CO/C（a-v） O2 ratio, P（cv-a）CO2with the rate of lactate clearance at each time point were compared respectively. Results： There was significant correlation between blood lactate and P （cv-a）COs/C （a-v）Os ratio, P（cv-a）CO2 respectively at each time point （r=0.873, 0.644（0h）, P〈0.01; 0.885, 0.585（6h）, P〈0.01; 0.858, 0.669（24h）, P〈0.01）, and the former was more significant than latter. There was significant correlation between the rate of lactate clearance and P （cv-a）CO2/C （a-v）O2 ratio, P （cv-a）COs respectively at each time point （r=0.874, 0.635（6 h）; 0.807, 0.530（24 h）, and P （cv-a） CO/C （a-v）O2 ratio is more significant than P （cv-a）COs （P 〈0.05）. Conclusion： P （cv-a）CO/C （a-cv）O2 ratio was superior to P （cv-a）CO2 in detecting the change of tissue anaerobic metabolism in fluid resuscitation.

关 键 词：高乳酸血症 乳酸清除率 中心动静脉二氧化碳分压差/氧含量差 中心动静脉二氧化碳分压差 液体复苏 

分 类 号：R631.2[医药卫生—外科学]