ScvO2联合P（cv-a）CO2在感染性休克患者液体复苏中的临床应用  

Clinical application of ScvO2 combined with P（cv-a）CO2 in fluid resuscitation of septic shock patients

作　　者：尚宝朋 李彦德 麦志伟 叶观宇 殷旭升 李志波[1] 陈国祥[1] SHANG Bao-peng;LI Yan-de;MAI Zhi-wei(Department of ICU, ZhongshanChenxinghai Hospital, Zhongshan, Guangdong, 528415,china)

机构地区：[1]中山市陈星海医院重症医学科

出　　处：《黑龙江医学》2019年第5期493-495,共3页Heilongjiang Medical Journal

摘　　要：目的分析感染性休克患者液体复苏中中心静脉血氧饱和度(ScvO2)联合中心静脉-动脉血二氧化碳分压差(P(cv-a)CO2)的临床应用价值。方法选取2017年1月—2018年11月期间在中山市陈星海医院60例经液体复苏治疗的感染性休克患者随机分为甲组与乙组。甲组31例,将ScvO2≥70%、P(cv-a)CO2<6mmHg作为复苏目标,乙组29例,仅将ScvO2≥70%作为复苏目标。比较两组多器官功能障碍综合征(MODS)出现率、死亡率,干预前后两组存活患者相关临床指标和干预效果。结果甲组MODS出现率、死亡率明显低于乙组(P<0.05);干预后两组中心静脉压(CVP)、平均动脉压(MAP)、ScvO2、心脏指数(CI)均升高(P<0.05),甲组明显高于乙组(P<0.05),血肌酐(Scr)均降低(P<0.05),甲组明显低于乙组(P<0.05);甲组存活患者6h乳酸清除率明显高于乙组(P<0.05),机械通气天数、重症加强护理病房(ICU)入住天数明显短于乙组(P<0.05)。结论感染性休克患者液体复苏中将ScvO2联合P(cv-a)CO2作为复苏目标,可降低MODS发生率、患者死亡率,改善临床指标,提升乳酸清除率,加快恢复速度。Objective To evaluate the clinical value of central venous oxygen saturation(ScvO2)combined with central venousarterial partial pressure of carbon dioxide(P(cv-a)CO2)in septic shock patients undergoing fluid resuscitation. Methods 60 septic shock patients treated with fluid resuscitation from January 2017 to November 2018 were randomly divided into group A and group B.31 cases in group A were treated with ScvO2 more than 70% and P(cv-a)CO2 less than 6 mmHg as recovery targets,while 29 cases in group B were treated with ScvO2 more than 70% as recovery targets only. The morbidity and mortality of multiple organ dysfunction syndrome(MODS)were compared between the two groups. The clinical indicators and intervention effects of survival patients in the two groups before and after intervention were compared. Results The morbidity and mortality of MODS in group A were significantly lower than that in group B(P<0.05). After the intervention,the central venous pressure(CVP),mean arterial pressure(MAP),ScvO2,and cardiac index(CI)of the two groups were all increased(P<0.05),which in group A was significantly higher than thosein group B(P<0.05),while the serum creatinine(Scr)was decreased(P<0.05),and the levels of Scr in group A was significantly lower than that in group B(P<0.05). The lactate clearance rate at 6 h in group A was significantly higher than that in group B(P<0.05),and the number of days of mechanical ventilation and intensive care unit(ICU)admission was significantly shorter than that in group B(P<0.05). Conclusion ScvO2 combined with P(cv-a)CO2 as resuscitation target in septic shock patients can reduce the morbidity of MODS and patient mortality,improve clinical indicators and lactate clearance rate,and speed up recovery.

关 键 词：中心静脉血氧饱和度 中心静脉-动脉血二氧化碳分压差 感染性休克 液体复苏 

分 类 号：R459.7[医药卫生—急诊医学]