P(cv-a)CO_2/C(a-v)O_2在内科ICU感染性休克患者液体复苏对组织氧耗量变化的预测价值  

The value of P(cv-a)CO_2/C(a-v)O_2 in ICU patients with septic shock under hemodynamic resuscitation to predict oxygen consumption

作　　者：张静[1] 刘晓姝[1] 解郑良[1] 郭璐[1] 杨阳[1] ZHANG Jing;LIU Xiaoshu;XIE Zhenliang;GUO Lu;YANG Yang(Department of respiratory and critical care medicine,Sichuan Academy of Medical Sciences&Sichuan Provincial Peoples Hospital,Chengdu 610072,China)

机构地区：[1]四川省人民医院呼吸与危重症医学科,成都610072

出　　处：《实用医学杂志》2018年第20期3418-3421,共4页The Journal of Practical Medicine

基　　金：四川省卫生厅课题(编号:18PJ443)

摘　　要：目的比较中心静脉氧合(ScvO_2)、P(cv-a)CO_2/C(a-v)O_2和无氧代谢标志物乳酸值在评价感染性休克患者液体复苏治疗有效性的预测价值。方法纳入2015年5月至2017年7月共计48例内科ICU感染性休克患者,500 mL生理盐水扩容前后,测量心排指数(CI)、中心静脉和动脉内Po_2和Pco_2的变化及动脉血乳酸值,并通过计算得到P(cv-a)CO_2/C(a-v)O_2,分析扩容前后CI、Do_2、Vo_2与P(cv-a)CO_2/C(a-v)O_2和乳酸之间的动态变化关系。结果扩容后CI增加≥15%的患者(容量反应性阳性组)占48%(23例),Do_2均明显增加(P <0.05),其中同时Vo_2有增加的12例(52%)。与容量反应性阳性组患者中Vo_2无增加的患者相比,Vo_2增加≥15%的患者特点为高乳酸(2.6±1.8)mmol/L对(5.8±3.9)mmol/L和高P(v-a)Co_2/C(a-v)O_2。扩容前的中心静脉血氧饱和度(ScvO_2)不能预测扩容是否能增加Vo2≥15%,但可以由扩容前的基础P(v-a)CO_2/C(a-v)O_2值预测。结论在容量反应性阳性的患者中,ScvO_2不能被用以预测是否扩容能增加Do_2和增加组织Vo_2,乳酸和P(cv-a)CO_2/C(a-v)O_2可以作为开始血流动力学复苏的指标。Objective Comparing the ability of central venous oxygen saturation,P(cv-a)CO2/C(a-v)O2 and markers of anaerobic metabolism to predict whether a fluid-induced increase in oxygen delivery(Do2)results in an increase in oxygen consumption(VO2)for patients with septic shock.Method Fourty-eight patients with an acute circulatory failure(all septic shock)were recruited.Before and after a volume expansion(500 mL of saline),we measured cardiac index,o2 and Co2 and lactate.P(cv-a)CO2/C(a-v)O2 were calculated from the change of o2 and Co2.We analysized the relationship of CI、Do2、Vo2 and P(cv-a)CO2/C(a-v)O2 and lactate.Results After volume expansion,cardiac index was increased(≥15%)in 48%of patients(“volume-responders”).Oxygen delivery was significantly increased in these 23 patients(P<0.05).An increase in oxygen consumption(≥15%)concomitantly occurred in 52%of these 12 volume-responders.Compared with the volume-responders in whom oxygen consumption were not increased,the volume-responders in whom oxygen consumption increased(≥15%)were characterized by a higher lactate[(2.6±1.8)mmol/L vs.(5.8±3.9)mmol/L,respectively]and a higher ratio of P(v-a)Co2/C(a-v)O2.A fluid-induced increase in oxygen consumption(≥15%)was not predicted by baseline central venous oxygen saturation but by high baseline of lactate and P(v-a)CO2/C(a-v)O2.Conclusions In volume-responders,unlike markers of anaerobic metabolism,central venous oxygen saturation is not allowed to predict whether a fluid-induced increase in oxygen delivery which results in an increase in oxygen consumption.This suggests that along with indicators of volume-responsiveness,the indicators of anaerobic metabo-lism should be considered to replace central venous oxygen saturation for starting hemodynamic resuscitation.

关 键 词：感染性休克 氧耗 氧输送 静动脉二氧化碳分压差 动静脉氧含量差 

分 类 号：R459.7[医药卫生—急诊医学]