血乳酸、混合静脉血氧饱和度(SVO_2)作为脓毒症休克患者液体复苏终点指标的临床有效性研究  

The Efficacy of Using Blood Lactic Acid and Mixed Venous Oxygen Saturation as the Endpoint of Fluid Resuscitationin Patients with Septic Shock

作　　者：杨文聪 尹建蓝 陈燕[3] WEN Cong-Yang;JIAN Yin;YAN Chen(Department of cardiovascular Department,The Seventh Affiliated Hospital of Sun Yat-sen University,518017;Department of Obstetrics and Gynecology,The Seventh Affiliated Hospital of Sun Yat-sen University;Department of intensive care unit,The Frist Affiliated Hospital of Sun Yat-sen University)

机构地区：[1]中山大学附属第七医院心血管内科,518017 [2]中山大学附属第七医院妇产科 [3]中山大学附属第一医院内科重症医学科

出　　处：《岭南急诊医学杂志》2018年第4期306-308,327,共4页Lingnan Journal of Emergency Medicine

摘　　要：目的:探讨血乳酸、混合静脉血氧饱和度(SVO_2)作为脓毒症休克患者液体复苏终点指标的临床有效性研究。方法:回顾性分析2014年6月-2016年12月在中山大学附属第一医院重症医学科住院治疗的120例脓毒症休克患者的一般资料、心率、MAP、CVP、SVO_2、血乳酸水平、尿量以及APACHEⅡ评分。治疗21天后,将患者按预后分为死亡组和存活组,按复苏6小时后血乳酸、SVO_2的值分为高血乳酸+高SVO_2组;高血乳酸+低SVO_2组;低血乳酸+高SVO_2组;低血乳酸+低SVO_2组,比较组间存活率和APACHEⅡ评分差异性。结果:120例脓毒症休克患者液体复苏6小时后MAP、CVP、SVO_2、尿量增高,血乳酸降低,差异具有统计学意义(P<0.05);心率变化无统计学差异(P>0.05)。低血乳酸+高SVO_2组死亡率和APACHEⅡ评分明显低于高血乳酸+低SVO_2组[10.2%vs60.0%,(21.6±2.34)vs(29.8±1.95),P<0.05]。结论:血乳酸和SVO_2两个指标作为脓毒症休克患者液体复苏终点指标优于单一指标,减少两项指标单独应用时自身影响因素的干扰,更加及时准确地评估患者液体复苏的程度。Objective： To investigate the clinical efficacy of blood lactic acid and mixed venous oxygen saturation（SVO2）as the endpoint of fluid resuscitation in patients with septic shock. Methods： A retrospective analysis of gener-al data,heart rate,MAP,CVP,SVO2,blood lactate levels,urine volume and APACHEⅡ score in 120 patients withseptic shock who were hospitalized in the Department of Critical Care Medicine,the First Affiliated Hospital of Sun Yat-sen University from June 2014 to December 2016. After 21 days of treatment,the patients were divided into the deathgroup and the survival group according to the prognosis. The patients were divided into high blood lactate ＋ high SVO2 group,high blood lactate ＋ low SVO2 group;low blood lactate ＋ high SVO2 group and low blood lactate according to thelevel of blood lactate and SVO2 after 6 hours of resuscitation. The differences of survival rate and APACHEⅡscore be-tween groups was compared. Result：After 6 hours of fluid resuscitation in 120 patients with septic shock,MAP,CVP,SVO2,urine volume and blood lactate decreased and the difference was statistically significant（P〈0.05）. There was nosignificant difference in heart rate（P〉0.05）. Mortality and APACHE Ⅱ scores in the low blood lactate ＋ high SVO2 group were significantly lower than those in the high blood lactate ＋ low SVO2 group[10.2% vs 60.0%,（21.6 ± 2.34）vs（29.8 ± 1.95）,P 〈0.05]. Conclusion： The combination of blood lactate and SVO2 as the fluid resuscitation endpointof patients with septic shock is better than the single index,which can reduce the interference of the two factors whenthe two factors are used alone,and more timely and accurate assessment of the degree of fluid resuscitation.

关 键 词：血乳酸 混合静脉血氧饱和度 脓毒症休克 

分 类 号：R459.7[医药卫生—急诊医学]