Pcv-aCO₂联合下腔静脉塌陷指数监测对高危手术患者液体复苏的指导意义  

Significance of Pcv-aCO2 Combined with Collapse Index of Inferior Vena Cava Monitoring in Guiding Fluid Resuscitation in High-Risk Surgery Patients

作　　者：李鹏程 郇铖 孟昭丽 郄国强[1] 王鹏[1] 王玉萍[1] 任宏生[1] 

机构地区：[1]山东大学附属省立医院重症医学科,山东 济南

出　　处：《临床医学进展》2020年第3期346-353,共8页Advances in Clinical Medicine

基　　金：山东省科技厅重点研发计划(2016GSF201052);济南市科技局临床医学科技创新计划(201602164)。

摘　　要：目的:探讨中心静脉–动脉二氧化碳分压差(Pcv-aCO2)联合下腔静脉塌陷指数(cIVC)监测对高危手术患者液体复苏的指导意义。方法:选取2018年06月~2019年12月山东省立医院ICU收治的86例高危外科术后合并休克的患者为研究对象,随机编入观察组与对照组。入组后常规留置中心静脉导管,按照早期目标导向治疗(EGDT)方案进行液体复苏,对照组以Pcv-aCO2为目标指导液体复苏,观察组以Pcv-aCO2联合cIVC为目标指导液体复苏。对比两组患者液体复苏前及复苏6 h后病人的HR、MAP、CVP、ScvO2、Pcv-aCO2、Lac及Lac清除率、尿量等监测指标变化,以及EGDT达标率、术后并发症发生率、28天死亡率差异。结果:液体复苏6 h后,两组患者HR、MAP、CVP、ScvO2、Pcv-aCO2、Lac较复苏前显著改善(P 2、Pcv-aCO2、尿量及EGDT达标率比较无显著差异(P 】0.05)。观察组术后并发症的发生率较对照组显著下降(P 0.05)。结论:Pcv-aCO2联合cIVC监测在指导高危手术患者液体复苏中有更好的应用价值,能更有效地改善患者组织灌注,纠正细胞缺氧,同时避免过度补液加重病情;两者均达标,乳酸清除率最高,术后并发症发生率最低。Objective: To investigate the value of central venous-to-arterial carbon dioxide difference (Pcv-aCO2) combined with collapse index of inferior vena cava (cIVC) monitoring in guiding fluid resuscitation in high-risk surgery patients. Methods: A total of 86 cases of high-risk postoperative patients with shock admitted to the ICU of Shandong Provincial Hospital from June 2018 to December 2019 were selected as the study objects, and were randomly divided into the Observation group and the Control group, with 43 cases in each group. The general indwelling central venous catheter was performed on the patients after their enrollment. Fluid resuscitation was initiated according to the early goal-directed therapy (EGDT) protocol for patients with shock. Fluid resuscitation in the control group was guided with the goal of Pcv-aCO2. Fluid resuscitation in the observation group was guided with the goal of Pcv-aCO2 combined with cIVC. The differences in HR, MAP, CVP, urine volume, ScvO2, Pcv-aCO2, Lac, LCR before and 6 h after fluid resuscitation, as well as EGDT compliance rate, postoperative complication rate and 28-day mortality were compared between the 2 groups. Results: After 6 h of fluid resuscitation, HR, MAP, CVP, ScvO2, Pcv-aCO2 and Lac in the 2 groups were significantly improved compared with those before resuscitation (P 2, Pcv-aCO2, urine volume, and EGDT compliance rate (P >0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group (P 0.05). Conclusion: Pcv-aCO2 combined with cIVC monitoring has a better application value in guiding fluid resuscitation in patients with high-risk surgery, which can effectively improve tissue perfusion, correct cell hypoxia, and avoid the aggravation of disease caused by excessive fluid infusion. Both comply with the requirement, with the highest lactate clearance rate and the lowest incidence of postoperative complications.

关 键 词：高危手术 液体复苏 中心静脉–动脉二氧化碳分压差(Pcv-aCO₂) 下腔静脉塌陷指数(cIVC) 

分 类 号：R47[医药卫生—护理学]