中心静脉血氧饱和度作为严重创伤低血容量休克患者容量复苏目标的生化指标的研究  

Central venous oxygen saturation as a predictor of the resuscitation goal in patients with severe traumatic hypovolemic shock

作　　者：吴舒沁 吴倩[1] 骆建军[1] 蒋光伟 王黎鹏[1] 邹春喜 杨箬箬 王晓霞[1] 朱新新 孟威 Wu Shuqin;Wu Qian;Luo Jianjun;Jiang Guangwei;Wang Lipeng;Zou Chunxi;Yang Ruoruo;Wang Xiaoxia;Zhu Xinxin;Meng Wei(Department of Intensive Care Unit,War Trauma Rescue Center,The 903rd Hospital of PLA Joint Logistics Support Force,Hangzhou 310013,China)

机构地区：[1]中国人民解放军联勤保障部队第九○三医院重症医学科、战创伤救治中心,杭州310013

出　　处：《创伤外科杂志》2021年第12期920-924,共5页Journal of Traumatic Surgery

摘　　要：目的评价中心静脉血氧饱和度(ScvO2)能否作为严重创伤低血容量休克患者容量复苏目标的一个生化指标。方法前瞻性研究中国人民解放军联勤保障部队第九○三医院2018年12月—2020年12月收治的48例严重创伤低血容量休克患者,男性28例,女性20例;年龄18~60岁,平均36.5岁;致伤原因道路交通伤34例,高处坠落伤6例,重物砸伤8例。入院后给予容量复苏,同时测定心脏指数(CI)、平均动脉压(MAP)、ScvO2及血乳酸(Lac),并每隔半小时测定以上指标。将容量负荷(给予10min快速输注250~500mL复方氯化钠)后CI增加值(△CI)<15%定义为液体反应阴性,作为容量复苏目标,测定并记录以上指标。远期目标观察指标为感染、序贯器官衰竭评估评分变化(△SOFA)及28d病死率。结果受试者工作特征(ROC)曲线结果显示ScvO271.2%可作为容量复苏目标,其敏感度是85.7%,特异度是70%;达到复苏目标时的ScvO2和Lac无明显相关性;根据ScvO2ROC曲线分成的≥71.2%和<71.2%两组,在远期目标观察指标方面比较差异有统计意义(P<0.05)。结论ScvO2可以作为严重创伤低血容量休克患者容量复苏目标的一个生化指标,在进行容量负荷后,患者恢复有效血容量时低ScvO2预示预后较差。Objective To evaluate whether central venous ogygen saturation(ScvO2)can be used as a biochemical indicator of volumetric resuscitation goals in patients with severe trauma hypovolemic shock.Methods Forty-eight patients of traumatic hypovolemic shock(28 males and 20 females,aged 18-60 years,with an average of 36.5 years;injury causes:traffic accident injury in 34 cases,high falling injury in 6 cases,bruise injury caused by heavy object in 8 cases)in Intensive Care Unit of the 903rd Hospital of PLA Joint Logistics Support Force from Dec.2018 to Dec.2020 were enrolled in this prospective observation study.The cardiac index(CI),mean arterial pressure(MAP),lactate(Lac)and ScvO2 were recorded at inclusion and every 0.5 hours.The resuscitation goal was defined as the changes in CI decrease after fluid loading(every patient was given 500mL compound sodium chloride for rapid intravenous infusion for 10 minutes)(△CI)<15%.The long-term objective observation indicators were defined as infections,△sequential organ failure assessment(△SOFA)score,and 28-day mortality.Results The receiver operating characteristic(ROC)curve results showed that ScvO271.2%can be used as a volume resuscitation target,with sensitivity of 85.7%and specificity of 70%;there was no significant correlation between ScvO2 and Lac when the resuscitation target was reached;according to ScvO2 ROC curve,they were divided into two groups:≥71.2%and<71.2%,and there was significant difference in the comparison of the long-term target observation indicators.Conclusion ScvO2 can be used as a biochemical indicator of the volumetric resuscitation goal of patients with severe traumatic hypovolemic shock.After volume loading,low ScvO2 when the patient recovers the effective blood volume indicates a poor prognosis.

关 键 词：创伤性休克 血氧饱和度 容量复苏 生化指标 

分 类 号：R641[医药卫生—外科学]