经皮-动脉血二氧化碳分压差在脓毒性休克液体复苏中的变化及意义  

Significance of changes of difference in percutaneous-arterial blood partial pressure of carbon dioxide in liquid resuscitation of patients with septic shock Fang

作　　者：方红龙[1] 陈娟[2] 罗建[1] 吴华勇[1] 陈梅琴 冯兴林[1] 王丹琼[1] 张伟文[1] Honglong;Chen Juan;Luo Jian;Wu Huayong;Chen Meiqin;Feng Xinglin;Wang Darujiong;Zhang Weiwen(Department o f Intensive Care Unit,Quzhou Peopled Hospital,Quzhou 324000,Zhejiang,China;Department o f Clinical Laboratory,Quzhou People's Hospital,Quzhou 324000,Zhejiang,China)

机构地区：[1]衢州市人民医院重症医学科,浙江衢州324000 [2]衢州市人民医院检验科,浙江衢州324000

出　　处：《中国中西医结合急救杂志》2019年第5期529-532,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省医药卫生科技计划项目(2017KY695);浙江省衢州市科技计划指导性项目(20172002)。

摘　　要：目的探讨经皮-动脉血二氧化碳分压差〔P(tc-a)CO2〕在脓毒性休克液体复苏中的变化及其意义.方法选择2015年1月至2018年1月衢州市人民医院重症医学科(ICU)住院的脓毒性休克患者168例,早期目标导向治疗(EGDT)6 h后根据中心静脉血氧饱和度(ScvO2)及乳酸清除率(LC)达标情况分为ScvO2和LC达标组(ScvO2≥0.7和LC≥10%)、单纯ScvO2达标组(ScvO2≥0.7和LC<10%)、单纯LC达标组(ScvO2<0.7和LC≥10%)、未达标组(ScvO2<0.7和LC<10%).比较4组机械通气时间、ICU住院时间、28 d病死率、P(tc-a)CO2等指标的差异;绘制受试者工作特征曲线(ROC)评价P(tc-a)CO2对脓毒性休克患者28 d预后的预测价值.结果机械通气时间、ICU住院时间、28 d病死率变化趋势均为ScvO2和LC达标组<单纯LC达标组<单纯ScvO2达标组<未达标组〔机械通气时间(d)分别为:6.12±2.59、8.43±3.24、11.78±4.12、13.03±4.75,ICU住院时间(d)分别为10.31±2.32、13.85±3.56、16.41±3.83、18.52±4.05,28 d病死率分别为28.85%(15/52)、40.91%(18/44)、51.28%(20/39)、69.70%(23/33)〕,且4组间比较差异有统计学意义(均P<0.05).EGDT 6 h后4组心率(HR)、乳酸(Lac)、P(tc-a)CO2均较液体复苏前降低,平均动脉压(MAP)、中心静脉压(CVP)、ScvO2均较液体复苏前升高;除CVP外,其余指标ScvO2和LC达标组、单纯ScvO2达标组、单纯LC达标组与未达标组比较差异均有统计学意义(均P<0.05).EGDT 6 h后,ScvO2和LC达标组、单纯ScvO2达标组、单纯LC达标组HR、Lac、P(tc-a)CO2均明显低于未达标组〔HR(次/min):89.05±29.43、98.82±30.21、94.33±28.64 比 112.85±32.74,Lac(mmol/L):2.97±1.95、3.87±2.32、2.69±1.52 比 4.17±2.44,P(tc-a)CO2 (mmHg,1 mmHg=0133 kPa):7.18±4.61、12.61±5.34、9.71±4.11比16.56±10.19〕,MAP、ScvO2均明显高于未达标组〔MAP(mmHg):88.05±21.67、77.33±18.56、83.11±19.71比70.32±18.79,ScvO2 :0.76±0.14、0.75±0.16、0.67±0.14比0.63±0.18,均P<0.05〕.ScvO2和LC达标组、单纯ScvO2达标组、�Objective To approach the significance of changes of percutaneous-arterial blood carbon dioxide partial pressure difference[P(tc-a)CO2]in liquid resuscitation of patients with septic shock.Methods One hundred and sixty-eight patients with septic shock admitted and treated in the Department of Intensive Care Unit(ICU)of Quzhou People's Hospital from January 2015 to January 2018 were enrolled,and after early goal-directed therapy(EGDT)for 6 hours,according to central venous oxygen saturation(ScvO2)and lactate clearance(LC),they were divided into ScvO2 and LC achievement group(ScvO2≥0.7 and LC≥10%),ScvO2 achievement group(ScvO2≥0.7 and LC<10%),LC achievement group(ScvO2<0.7 and LC≥10%),and un-achievement group(ScvO2<0.7 and LC<10%).The mechanical ventilation time,ICU hospitalization time,28-day mortality,P(tc-a)CO2 etc.were compared among the four groups;the receiver operating characteristic curve(ROC)was used to evaluate the predictive value of P(tc-a)CO2 for 28-day prognosis in patients with septic shock.Results The trends of mechanical ventilation time,ICU hospitalization time,and 28-day mortality were all ScvO2 and LC achievement group<LC achievement group<ScvO2 achievement group<un-achievement group[the mechanical ventilation times(days)were respectively 6.12±2.59,8.43±3.24,11.78±4.12,13.03±4.75,ICU hospitalization times(days)were 10.31±2.32,13.85±3.56,16.41±3.83,18.52±4.05,and 28-day mortality rates were 28.85%(15/52),40.91%(18/44),51.28%(20/39),69.70%(23/33)]and the differences among the four groups were statistically significant(all P<0.05).After 6 hours of EGDT,the heart rate(HR),lactate(Lac),and P(tc-a)CO2 were lower than those before fluid resuscitation,but the mean arterial pressure(MAP),central venous pressure(CVP),and ScvO2 were higher than those before fluid resuscitation among four groups.Except CVP,the differences of other indicators compared among the ScvO2 and LC achievement group,ScvO2 achievement group,LC achievement group and un-achievement group were statistically significant(a

关 键 词：经皮-动脉血二氧化碳分压 脓毒性休克 液体复苏 

分 类 号：R54[医药卫生—心血管疾病]