脓毒性休克患者Cv-aCO_2/Ca-vO_2、乳酸清除率与IVCrvi的关系  

Study on correlation between Cv-aCO_2/Ca-vO_2,LCR and IVCrvi in patients with septic shock

作　　者：王兆[1] 杨蕾[1] 温建立[1] 唐春春[1] 陈微微[1] 唐洪波[1] 王国贤[1] 刘微[1] Zhao Wang;Lei Yang;Jian-li Wen;Chun-chun Tang;Wei-wei Chen;Hong-bo Tang;Guo-xian Wang;Wei Liu(Department of Intensive Care Unit,the First People’s Hospital of Zunyi,Zunyi,Guizhou 563001,China)

机构地区：[1]遵义市第一人民医院重症医学科,贵州遵义563001

出　　处：《中国现代医学杂志》2019年第4期73-77,共5页China Journal of Modern Medicine

基　　金：贵州省遵义市科学技术局资金资助项目[No:遵市科合社字(2016)14号]

摘　　要：目的探讨脓毒性休克患者静脉-动脉血二氧化碳含量差与动脉-静脉血氧含量差的比值(Cva CO_2/Ca-v O_2)、乳酸与下腔静脉内径呼吸变异指数(IVCrvi)的关系。方法选取2016年6月—2018年2月遵义市第一人民医院收治的66例脓毒性休克患者,随机分为A组(23例)、B组(21例)及C组(22例)。采用连续多普勒无创血液动力学监测仪记录患者血流动力学数据,在抗感染、早期复苏等基础上,A组加用Cv-aCO_2/Ca-vO_2<1.1作为24 h复苏终点指导治疗;B组加用乳酸清除率>50%作为24 h复苏终点指导治疗;C组加用IVCrvi<30%作为24 h复苏终点指导治疗。观察3组治疗前后急性生理学与慢性健康状况评估Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、平均动脉压(MAP)、中心静脉压(CVP)、氧气指数(PaO_2/FiO_2)、中心静脉血氧饱和度(ScvO2)、每搏量变异度(SVV)、心脏指数(CI)、外周血管阻力指数(SVRI)、降钙素原(PCT)及28 d病死率等变化。结果 3组治疗前APACHEⅡ评分、SOFA评分、MAP、血乳酸水平及PCT水平比较,差异无统计学意义(P>0.05);3组治疗6 h后CVP水平比较,差异有统计学意义(P <0.05);3组MAP值、达到目标MAP所需液体量、PaO_2/FiO_2、心率(HR)及乳酸值比较,差异无统计学意义(P>0.05);3组治疗24 h后,中心静脉动脉二氧化碳分压差(Pcv-a CO_2)、SVRI及脑肽钠比较,差异无统计学意义(P>0.05),而ScvO_2、WBC比较,差异有统计学意义(P <0.05);3组治疗7 d后,CI、SVRI、氧输送(DO_2)及PCT比较,差异无统计学意义(P>0.05),而SVV值比较,差异有统计学意义(P <0.05);3组28 d总CBP时间、机械通气时间、住ICU时间及28 d病死率比较,差异无统计学意义(P>0.05)。结论 Cv-aCO_2/Ca-vO_2、乳酸清除率与IVCrvi有关。Objective To explore the correlation between the ratio of the difference of carbon dioxide content in venous and arterial blood to the difference of oxygen content in arterial and venous(Cv-aCO2/Ca-vO2),the lactate clearance rate(LAC)and the respiratory variations index of inferior vena cava(IVCrvi)in patients with septic shock.Methods Totally 66 patients with septic shock treated from June 2016 to February 2018 in our hospital were randomly divided into group A(23 cases),group B(21 cases)and group C(22 cases).Using USCOM to record the patient’s hemodynamic data,based on anti-infection and early resuscitation,group A was treated with Cv-aCO2/Ca-vO2<1.1 as the guide for the end point of 24-hour resuscitation;group B was treated with LCR >50%to guide the end point of the 24-hour resuscitation;group C was treated with IVCrvi<30%to guide the end point of the 24-hour resuscitation.The changes of APACHE II score,SOFA score,MAP,CVP,PaO2/FiO2,ScvO2,SVV,CI,SVRI,PCT,28-day mortality and so on in patients before and after treatment were observed.Results There was no significant difference in SOFA score,MAP,levels of blood Lac level and PCT among three groups before treatment(P >0.05);there was a significant difference in CVP after 6-hour treatment(P<0.05).There was no significant difference in the values of MAP,the amount of fluid needed to reach the target MAP,PaO2/FiO2,HR and Lac among three groups(P >0.05);after 24 hours of treatment,there was no significant difference in P(Cv-a)CO2,SVRI and brain peptide sodium(BNP)(P >0.05),but there were significant differences in the values of ScvO2 and WBC(P<0.05).After 7 days of treatment,there was no significant difference in CI,SVRI,DO2 and PCT among three groups(P >0.05),but there was a significant difference in SVV(P<0.05);there was no significant difference in total CBP time,mechanical ventilation time,ICU stay time and 28-day mortality among three groups(P >0.05).Conclusions Cv-aCO2/Ca-vO2 and LCR have a positive correlation with IVCrvi.

关 键 词：休克 脓毒性 血气分析 血液动力学 乳酸 

分 类 号：R543.2[医药卫生—心血管疾病]