静-动脉血二氧化碳含量差/动-静脉血氧含量差和外周灌注指数对感染性休克患者预后的影响  

Effect of Cv-aCO2/Da-vO2 and Peripheral Perfusion Index on the Prognosis of Patients with Septic Shock

作　　者：臧会玲[1] 张笑娣 王生池[1] 程慧[1] 沈晓辉[1] ZANG Hui-ling;ZHANG Xiao-di;WANG Sheng-chi;CHENG Hui;SHEN Xiao-Hui(Department of Critical Care Medicine,the First Hospital of Shijiazhuang City,Shijiazhuang 050011,China;Department of Neurology,the First Hospital of Shijiazhuang City,Shijiazhuang 050011,China)

机构地区：[1]石家庄市第一医院重症医学科,石家庄050011 [2]石家庄市第一医院神经内科,石家庄050011

出　　处：《解放军医药杂志》2020年第12期68-71,76,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：石家庄市科学技术研究与发展指导计划(151460623);首都特色应用研究专项基金(Z181100001718026)。

摘　　要：目的探讨液体复苏过程中静-动脉血二氧化碳含量差/动-静脉血氧含量差(Cv-aCO 2/Da-vO 2)和外周灌注指数(PI)对感染性休克患者预后的影响。方法选取2012年1月—2017年12月收治的106例感染性休克患者,按照2012年脓毒症指南进行液体复苏。记录液体复苏6 h时患者血流动力学参数、氧代谢参数和乳酸(Lac)水平,以及复苏第3天序贯器官衰竭评估(SOFA)评分和28 d全因死亡率。并进行影响因素和相关性分析。结果液体复苏第3天的SOFA评分较第1天明显降低(P<0.01)。复苏6 h的Lac水平较入组时明显降低(P<0.01)。存活组复苏6 h的Lac以及复苏第3天SOFA评分均低于死亡组(P<0.05,P<0.01)。存活组复苏6 h的Cv-aCO 2/Da-vO 2≤1患者比例和PI≥0.6患者比例均显著高于死亡组(P<0.01)。复苏6 h的Cv-aCO 2/Da-vO 2、PI、Lac以及复苏第3天的SOFA评分是感染性休克患者28 d全因死亡率的影响因素(P<0.05,P<0.01)。复苏6 h的Cv-aCO 2/Da-vO 2与28 d全因死亡率呈正相关(r s=0.429,P<0.001),复苏6 h的PI与28天全因死亡率呈负相关(r s=-0.545,P<0.001)。结论在感染性休克液体复苏中,Cv-aCO 2/Da-vO 2和PI是28 d全因死亡率的影响因素,能以纠正Cv-aCO 2/Da-vO 2和PI为目标指导液体复苏。Objective To investigate the effect of Cv-aCO 2/Da-vO 2 and peripheral perfusion index(PI)on the prognosis of patients with septic shock during fluid resuscitation.Methods A total of 106 patients with septic shock admitted from January 2012 to December 2017 were selected for fluid resuscitation in accordance with the 2012 Sepsis Guidelines.Hemodynamic parameters,oxygen metabolism parameters and lactate(Lac)levels were recorded at 6 h after fluid resuscitation,as well as sequential organ failure assessment(SOFA)score at 3 d after resuscitation and 28-day all-cause mortality.The influencing factors and correlation analysis were conducted.Results The SOFA score at 3 after fluid resuscitation was significantly lower than that at 1 day(P<0.01).The Lac level at 6 h after resuscitation was significantly lower than that at the time of enrollment(P<0.01).The Lac level of the survival group at 6 h after resuscitation and the SOFA scores at 3 days of resuscitation were lower than those of the death group(P<0.05,P<0.01).The proportion of patients with Cv-aCO 2/Da-vO 2≤1 and the proportion of patients with PI≥0.6 in the survival group at 6 h after resuscitation were significantly higher than those in the death group(P<0.01).Cv-aCO 2/Da-vO 2,PI,Lac at 6 h after resuscitation and SOFA score at 3 days after resuscitation were influencing factors for 28-day all-cause mortality in patients with septic shock(P<0.05,P<0.01).Cv-aCO 2/Da-vO 2 at 6 h after resuscitation was positively correlated with 28-day all-cause mortality(r s=0.429,P<0.001),and PI at 6 h after resuscitation was negatively correlated with 28-day all-cause mortality(r s=-0.545,P<0.001).Conclusion In fluid resuscitation in septic shock,Cv-aCO 2/Da-vO 2 and PI are the influencing factors of 28-day all-cause mortality.Correcting Cv-aCO 2/Da-vO 2 and PI can guide fluid resuscitation.

关 键 词：感染性休克 Cv-aCO 2/Da-vO 2 外周灌注指数 乳酸 死亡率 预后 

分 类 号：R631.4[医药卫生—外科学]