CVP、重症超声联合(Pv-aCO_(2))/(Ca-vO_(2))在机械通气患者容量管理中的指导价值及对血流动力学、Lac、机械通气时间的影响  

GUIDING VALUE OF CVP AND CRITICAL ULTRASOUND (PV-aCO_(2))/(CA-vO_(2)) IN VOLUME MANAGEMENT OF MECHANICALLY VENTILATED PATIENTS AND THEIR INFLUENCE ON HEMODYNAMICS,LAC AND MECHANICAL VENTILATION TIME

作　　者：任雪莲[1] 文海燕[1] 刘冬辉 REN Xuelian;WEN Haiyan;LIU Donghui(Department of Intensive Medicine,Second Central Hospital of Baoding City jZhuozhou 072750,China)

机构地区：[1]保定市第二中心医院重症医学科,河北省涿州市072750

出　　处：《中国煤炭工业医学杂志》2022年第1期86-90,共5页Chinese Journal of Coal Industry Medicine

基　　金：河北省重点研发计划项目(编号:20377724D)。

摘　　要：目的探讨中心静脉压(CVP)、重症超声联合静-动脉二氧化碳分压差(Pv-aCO_(2))/动-静脉氧含量差(Ca-vO_(2))在机械通气患者容量管理中的指导价值及对血流动力学、乳酸(Lac)、机械通气时间的影响。方法选取2018年6月—2020年6月该院收治的104例脓毒症休克机械通气患者,随机数字表法分为二组,各52例。二组均给予液体复苏治疗,对照组通过监测CVP指导容量管理,观察组在对照组基础上加用重症超声联合(Pv-aCO_(2))/(Ca-vO_(2))指导容量管理。比较二组复苏前、6 h、24 h血流动力学指标[心率(HR)、中心静脉血氧饱和度(ScvO_(2))、平均动脉压(MAP)、(Pv-aCO_(2))/(Ca-vO_(2))]、6 h液体复苏量、血管活性药物用量、机械通气时间、ICU住院时间、急性生理和慢性健康状况评分(APACHEⅡ)、序贯器官衰竭(SOFA)评分、Lac。结果观察组6 h、24 h HR、(Pv-aCO_(2))/(Ca-vO_(2))低于对照组,ScvO_(2)、MAP高于对照组(P<0.05);观察组6h液体复苏量、血管活性药物用量低于对照组,机械通气时间、ICU住院时间短于对照组(P<0.05);观察组6hLac及24hAPACHEⅡ评分、SOFA评分、Lac均低于对照组(P<0.05),以上差异均有统计学意义。结论CVP、重症超声联合(Pv-aCO_(2))/(Ca-vO_(2))应用于机械通气患者容量管理中,可改善机体血流动力学,减少Lac产生,缩短机械通气时间,改善疾病预后,可更精确地指导液体复苏,对机械通气患者容量管理具有重大指导意义。Objective To explore the guiding value of central venous pressure(CVP),critical ultrasound combined with intravenous-arterial carbon dioxide partial pressure difference(Pv-aCO_(2))/(Ca-vO_(2)) in volume management of mechanically ventilated patients and its influence on hemodynamics, lactic acid(Lac) and mechanical ventilation time.Methods From June 2018 to June 2020,one hundred and four mechanically ventilated patients with septic shock in our hospital were selected and divided into two groups by random number table, 52 cases in each group.Both groups were given fluid resuscitation therapy.The control group was guided by monitoring CVP for volume management, and the observation group was supplemented by the control group with critical ultrasound combined with(Pv-aCO_(2))/(Ca-vO_(2)) to guide volume management.The hemodynamic indexes[heart rate(HR),saturation central venous oxygen(ScvO_(2)),mean arterial pressure(MAP),(Pv-aCO_(2))/(Ca-vO_(2))] before resuscitation, 6 h and 24 h, 6-hour fluid resuscitation amount, vasoactive drug dosage, mechanical ventilation time, ICU hospitalization time, acute physiology and chronic health score(APACHE Ⅱ),sequential organ failure assessment(SOFA) scoreand Lacwere compared between the two groups.Results The 6 h and 24 h HR and(Pv-aCO_(2))/(Ca-vO_(2)) of the observation group were lower than those of the control group, and ScvO_(2)and MAP were higher than those of the control group(P<0.05).The amount of fluid resuscitation and the amount of vasoactive drugs in the observation group at 6 hours were lower than those in the control group, and the mechanical ventilation time and ICU hospital stay were shorter than those in the control group(P<0.05).The 6 h Lac and 24 h APACHE Ⅱ score, SOFA score and Lac ofthe observation group were lower than those of the control group(P<0.05),all above differences were statistically significant.Conclusion CVP,critical ultrasound combined with(Pv-aCO_(2))/(Ca-vO_(2)) applied in volume management of mechanically ventilated patients can improve th

关 键 词：机械通气 静-动脉二氧化碳分压差/动-静脉氧含量差 血流动力学 机械通气时间 

分 类 号：R562[医药卫生—呼吸系统]