严重创伤休克患者采用中心静脉二氧化碳分压和上腔静脉血氧饱和度指导复苏效果  

Recovery effect of central venous partial pressure of carbon dioxide and superior vena cava oxygen saturation in patients with severe traumatic shock

作　　者：卢广轩 覃炳军[1] 曾晖[1] 范彦琦[1] 安曙光[1] 

机构地区：[1]广东省东莞市人民医院重症监护室,广东东莞523000

出　　处：《中国医药科学》2016年第18期156-158,184,共4页China Medicine And Pharmacy

基　　金：广东省东莞市科技计划项目(20131051010088)

摘　　要：目的探讨严重创伤休克患者采用中心静脉二氧化碳分压（Pcv—aCO2）和上腔静脉血氧饱和度（ScvO2）指导复苏效果。方法选取2014年3月-2016年1月我院收治严重创伤性休克患者64例为研究对象，积极进行液体复苏，根据患者复苏6h后Pcv—aCO2是否≥6mmHg分为高压组和低压组，所有患者积极治疗1个月后根据是否存活分为存活组和死亡组，分别比较复苏前和复苏6h后及各组患者平均动脉压（MAP）、心率（HR）、ScvO2、Pcv—aCO2、中心静脉压（CVP）及乳酸水平。结果复苏后患者MAP、ScvO2、CVP水平较复苏前显著升高，HR、Pcv—aCO2、乳酸水平较复苏后显著降低，比较差异有统计学意义（P〈0．05）。64例患者经积极复苏6h后，Pcv—aCO2≥6mmHg患者18例，Pcv—aCO2〈6mmHg患者46例。低压组患者MAP、ScvO2水平显著高于高压组，HR显著低于高压组，比较差异有统计学意义（P〈0．05）。经积极治疗1个月后，64例患者存活29例，死亡35例。存活组患者入院时ScvO2显著高于死亡组，HR、Pcv—aCO2、乳酸水平显著低于死亡组，比较差异有统计学意义（P〈0．05）。结论Pcv—aCO2和ScvO2水平可作为评定严重创伤性休克患者预后指标，在严重创伤性休克患者复苏有重要指导作用。Objective To investigate the effects of central venous carbon dioxide partial pressure （Pcv-aCO2） and superior vena eava oxygen saturation （ScvO2） on recovery in patients with severe traumatic shock. Methods 64 patients with severe traumatic shock treated with liquid resuscitation from March 2014 Io January 2016 were selected as the study objects. According to whether or not Pcv-aCO2≥6 mmHg after 6 h of resuscitation, they were divided into high pressure group and low pressure group. Central venous pressure （MAP）, ScvO2, Pcv-aCO2, heart rate （HR）, Central venous pressure （CVP） and lactate levels were measured before and after the resuscitation and 6 hours after resuscitation, respectively. Results The levels of MAP, ScvO2 and CVP after resuscitation were significantly higher than those before resuscitation, and the levels of HR, Pcv-aCO2 and lactate were significantly lower than those after resuscitation （P 〈 0.05）. 64 patients with active resuscitation after 6h, Pcv-aCO2≥ 6mmHg in 18 patients, Pcv-aCO2 〈 6mmHg patients in 46 cases. The levels of MAP and ScvO2 in the low-pressure group were significantly higher than those in the high-pressure group （P 〈 0.05）. After active treatment in January, 64 patients survived in 29 cases, 35 patients died. The levels of HR, Pcv-aCO2 and lactate were significantly lower in the survival group than in the death group （P 〈 0.05）. Conclusion Pcv-aCO2 and ScvO2 levels can be used as indicators of prognosis of patients with severe traumatic shock, They have an important role in the recovery of patients with severe traumatic shock.

关 键 词：严重创伤休克 中心静脉二氧化碳分压 上腔静脉血氧饱和度 复苏效果 

分 类 号：R459.7[医药卫生—急诊医学]