混合静脉-动脉血二氧化碳分压差联合下腔静脉直径指导脓毒性休克患者液体复苏的临床研究  

Clinical Study on Fluid Resuscitation in Patients with Septic Shock Guided by Mixed Central Veno-arterial Carbon Dioxide Differential Pressure Combined with Inferior Vena Cava Diameter

作　　者：顾雯 江怡 胡杰 GU Wen;JIANG Yi;HU Jie(Department of Critical Care Medicine,Xinyu People's Hospital,Xinyu 338000,China;不详)

机构地区：[1]新余市人民医院重症医学科,江西新余338000 [2]新余市中医院重症医学科,江西新余338000

出　　处：《中国医学创新》2024年第23期74-77,共4页Medical Innovation of China

基　　金：新余市社会发展指导性科技计划项目(20233090825)。

摘　　要：目的:探讨混合静脉-动脉血二氧化碳分压差(Pcv-aCO_(2))联合下腔静脉直径(IVCD)指导脓毒性休克(SS)患者液体复苏的临床效果。方法:选取2022年1月—2023年6月新余市人民医院收治的83例SS患者,按随机数字表法分为对照组(n=42)、观察组(n=41);对照组行3 h集束化液体复苏,观察组于Pcv-aCO_(2)联合IVCD指导下行液体复苏;比较两组复苏相关指标、6 h复苏达标率与乳酸清除率、复苏6 h与24 h液体总入量、机械通气时间与急性肺水肿发生率。结果:复苏6、24 h,观察组中心静脉压(CVP)、平均动脉压(MAP)、中心静脉血氧饱和度(ScvO_(2))均高于对照组,乳酸(Lac)均低于对照组,差异均有统计学意义(P<0.05)。观察组6 h复苏达标率与乳酸清除率均高于对照组,差异均有统计学意义(P<0.05);复苏6、24 h,观察组液体总入量均少于对照组,差异均有统计学意义(P<0.05);观察组机械通气时间短于对照组,急性肺水肿发生率低于对照组,差异均有统计学意义(P<0.05)。结论:Pcv-aCO_(2)联合IVCD指导SS患者行液体复苏可提高复苏达标率,减少液体总入量,缩短机械通气时间,且可降低急性肺水肿发生率。Objective:To investigate the clinical effect of mixed cantral veno-arterial carbon dioxide differential pressure(Pcv-aCO_(2))combined with inferior vena cava diameter(IVCD)on fluid resuscitation in patients with septic shock(SS).Method:A total of 83 SS patients admitted to Xinyu People's Hospital from January 2022 to June 2023 were selected and divided into control group(n=42)and observation group(n=41)according to random number table method.The control group received 3 h liquid resuscitation,and the observation group received liquid resuscitation under the guidance of Pcv-aCO_(2)combined with IVCD.The indexes related to resuscitation,6 h resuscitation standard rate and lactic acid clearance rate,total fluid intake at 6 h and 24 h after resuscitation,mechanical ventilation time and incidence of acute pulmonary edema between the two groups were compared.Result:At 6 h and 24 h after resuscitation,central venous pressure(CVP),mean arterial pressure(MAP)and central venous oxygen saturation(ScvO_(2))in observation group were higher than those in control group,and lactic acid(Lac)were lower than those in control group,the differences were statistically significant(P<0.05).The 6 h resuscitation standard rate and lactic acid clearance rate in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).At 6 h and 24 h after resuscitation,the total fluid intake in the observation group were less than those in the control group,the differences were statistically significant(P<0.05).The mechanical ventilation time of the observation group was shorter than that of the control group,and the incidence of acute pulmonary edema was lower than that of the control group,the differences were statistically significant(P<0.05).Conclusion:Pcv-aCO_(2)combined with IVCD can improve the standard rate of resuscitation,reduce the total fluid intake,shorten the mechanical ventilation time,and reduce the incidence of acute pulmonary edema in SS patients.

关 键 词：脓毒性休克 混合静脉-动脉血二氧化碳分压差 下腔静脉直径 液体复苏 

分 类 号：R459.7[医药卫生—急诊医学]