中心静脉-动脉二氧化碳分压差对脓毒症休克患者早期液体复苏指导价值的临床研究  

Value of central venous-arterial carbon dioxide difference in initial fluid resuscitation towards patients with septic shock

作　　者：卿楠 李晶文 颉永乐[1] 苏文涛[1] 辛宏伟[1] 田静[1] 李云[1] 祝俊年 Qing Nan;Li Jingwen;Xie Yongle;Su Wentao;Xin Hongwei;Tian Jing;Li Yun;Zhu Junnian(Department of Intensive Care Unit,Tianshui No.1 Hospital,Tianshui 741000,China)

机构地区：[1]天水市第一人民医院重症医学科

出　　处：《临床荟萃》2019年第10期907-910,共4页Clinical Focus

摘　　要：目的探讨中心静脉-动脉二氧化碳分压差(Pcv-aCO 2)对感染性休克患者早期液体复苏的指导价值。方法收集2016年1月至2018年12月天水市第一人民医院重症医学科105例感染性休克患者,对所有脓毒症休克患者根据早期目标导向治疗方案进行复苏治疗,分别于复苏前、复苏后6小时同时行桡动脉和上腔静脉血气分析,并计算Pcv-aCO 2。根据液体复苏后6小时乳酸和Pcv-aCO 2分为4组:A组:乳酸>2 mmol/L,Pcv-aCO 2<6 mmHg(1 kPa=0.133 mmHg);B组:乳酸>2 mmol/L,Pcv-aCO 2≥6 mmHg;C组:乳酸<2 mmol/L,Pcv-aCO 2<6 mmHg;D组:乳酸<2 mmol/L,Pcv-aCO 2≥6 mmHg。记录患者第1天、第3天的序贯器官衰竭评估(SOFA)评分、ICU住院天数及28 d病死率。结果复苏后各组心率低于复苏前,平均动脉压、中心静脉压及中心静脉氧饱和度高于复苏前(P<0.05);复苏后C、D组乳酸水平较A、B组低(P<0.05),A、C组Pcv-aCO 2水平较B、D组低(P<0.05);第3天SOFA评分、28 d病死率C组较其余3组低(P<0.05)。结论感染性休克早期液体复苏阶段,Pcv-aCO 2及乳酸均达标预后更好,可指导早期液体复苏。Objective To evaluate the guidance value of venous-arterial carbon dioxide difference(Pcv-aCO 2)in fluid resuscitation towards patients with septic shock.Methods A total of 105 patients with septic shock admitted to ICU of the hospital from January 2016 to December 2018 were collected.All patients underwent initial resuscitation on the basis of the early goal directed therapy principle.The blood gases analysis of radial artery and superior vena cava were carried out simultaneously 6 hours before resuscitation and 6 hours after resuscitation,Pcv-aCO2 was also calculated.The patients were divided into four groups on the basis of lactic acid(lac)level and Pcv-aCO 26 hours after fluid resuscitation:group A,lac>2 mmol/L,Pcv-aCO 2<6 mmHg;group B,lac>2 mmol/L,Pcv-aCO 2≥6 mmHg;group C,lac<2 mmol/L,Pcv-aCO 2<6 mmHg;group D,lac<2 mmol/L,Pcv-aCO 2≥6 mmHg.Sequential Organ Failure Assessment(SOFA)scores at day-1 and day-3,length of ICU stay and 28-day motality of all four groups were recorded.Results After resuscitation,the heart rate(HR)of the patients of all four groups was lower than that before resuscitation,while mean arterial pressure,central venous pressure and central venous oxygen saturation were higher than those before resuscitation(P<0.05).The lac level of group C and D were lower than that of group A and B after resuscitation;Pcv-aCO 2 of group A and C were lower than that of group B and D(P<0.05).Moreover,SOFA score at day-3,28-day motality of group C were lower than that of the rest three groups(P<0.05).Conclusion During the initial resuscitation towards spetic shock patients,those whose Pcv-aCO 2 and lac level reach the criterion will have a better prognosis.Also,Pcv-aCO 2 combined with lac level can guide the initial resuscitation towards patients with septic shock.

关 键 词：休克 脓毒性 中心静脉-动脉二氧化碳分压差 乳酸 

分 类 号：R631.4[医药卫生—外科学]