中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2012年
1期
86-88
,共3页
韩玉%代庆春%沈洪丽%苗晓云%回志%张晓卫
韓玉%代慶春%瀋洪麗%苗曉雲%迴誌%張曉衛
한옥%대경춘%침홍려%묘효운%회지%장효위
心排血量%中心静脉压%补液疗法%休克,脓毒性
心排血量%中心靜脈壓%補液療法%休剋,膿毒性
심배혈량%중심정맥압%보액요법%휴극,농독성
Cardiac output%Central venous pressure%Fluid therapy%Shock,septic
目的 评价中心静脉压(CVP)联合全心舒张末容积指数(GEDVI)指导感染性休克患者容量治疗的效果.方法 感染性休克患者23例,性别不煨,年龄18～64岁,休克时间＜6h,急性生理和慢性健康状况评分13～31分,采用随机数字表法,将其随机分为2组:CVP指导容量治疗组(Ⅰ组,n=12)和CVP联合GEDVI指导容量治疗组(Ⅱ组,n=11).2组均静脉输注生理盐水和6％羟乙基淀粉200/0.5,晶体液和胶体液的比例为1∶(0.5 ～ 1.0),输注速率800～ 1600 ml/h,容量治疗过程中Ⅰ组维持CVP8～ 12mmHg；Ⅱ组维持CVP＞8 mm Hg和GEDVI 600 ～ 750 ml/m2.分别于容量治疗前及容量治疗开始后6h时采集动脉及中心静脉的血样,测定血乳酸浓度和中心静脉血氧饱和度(ScvO2),计算乳酸和ScvO2的变化率.结果 与Ⅰ组比较,Ⅱ组乳酸变化率升高(P＜0.05),ScvO2变化率差异无统计学意义(P＞0.05).结论 与CVP指导容量治疗比较,CVP联合GEDVI指导感染性休克患者容量治疗时可增加组织灌注,其效果较好.
目的 評價中心靜脈壓(CVP)聯閤全心舒張末容積指數(GEDVI)指導感染性休剋患者容量治療的效果.方法 感染性休剋患者23例,性彆不煨,年齡18～64歲,休剋時間＜6h,急性生理和慢性健康狀況評分13～31分,採用隨機數字錶法,將其隨機分為2組:CVP指導容量治療組(Ⅰ組,n=12)和CVP聯閤GEDVI指導容量治療組(Ⅱ組,n=11).2組均靜脈輸註生理鹽水和6％羥乙基澱粉200/0.5,晶體液和膠體液的比例為1∶(0.5 ～ 1.0),輸註速率800～ 1600 ml/h,容量治療過程中Ⅰ組維持CVP8～ 12mmHg；Ⅱ組維持CVP＞8 mm Hg和GEDVI 600 ～ 750 ml/m2.分彆于容量治療前及容量治療開始後6h時採集動脈及中心靜脈的血樣,測定血乳痠濃度和中心靜脈血氧飽和度(ScvO2),計算乳痠和ScvO2的變化率.結果 與Ⅰ組比較,Ⅱ組乳痠變化率升高(P＜0.05),ScvO2變化率差異無統計學意義(P＞0.05).結論 與CVP指導容量治療比較,CVP聯閤GEDVI指導感染性休剋患者容量治療時可增加組織灌註,其效果較好.
목적 평개중심정맥압(CVP)연합전심서장말용적지수(GEDVI)지도감염성휴극환자용량치료적효과.방법 감염성휴극환자23례,성별불외,년령18～64세,휴극시간＜6h,급성생리화만성건강상황평분13～31분,채용수궤수자표법,장기수궤분위2조:CVP지도용량치료조(Ⅰ조,n=12)화CVP연합GEDVI지도용량치료조(Ⅱ조,n=11).2조균정맥수주생리염수화6％간을기정분200/0.5,정체액화효체액적비례위1∶(0.5 ～ 1.0),수주속솔800～ 1600 ml/h,용량치료과정중Ⅰ조유지CVP8～ 12mmHg；Ⅱ조유지CVP＞8 mm Hg화GEDVI 600 ～ 750 ml/m2.분별우용량치료전급용량치료개시후6h시채집동맥급중심정맥적혈양,측정혈유산농도화중심정맥혈양포화도(ScvO2),계산유산화ScvO2적변화솔.결과 여Ⅰ조비교,Ⅱ조유산변화솔승고(P＜0.05),ScvO2변화솔차이무통계학의의(P＞0.05).결론 여CVP지도용량치료비교,CVP연합GEDVI지도감염성휴극환자용량치료시가증가조직관주,기효과교호.
Objective To evaluate the effectiveness of volume therapy guided by the response of CVP and global end-diastolic volume index (GEDVI) in septic shock patients.Methods Twenty-three patients of both sexes aged 18-64 yr who had been in septic shock for ＜ 6 h were randomly divided into 2 groups:control group (group Ⅰ,n =12) and study group (group Ⅱ,n =11 ).Tracheal intubation was performed and the patients were mechanically ventilated in both groups.Right internal jugular vein or subclavian vein was cannulated for CVP monitoring and fluid administration.PiCCO catheter was inserted into femoral artery.Normal saline,6％ hydroxyethyl starch 200/0.5,albumin and plasma were infused via CVP line.CVP was maintained ≥8 mm Hg in both groups while in Ⅱ group GEDVI was maintained at 600-750 ml/m2 during resuscitation.Blood samples were taken from artery and CVP line before (baseline) and at 6 h of volume therapy (T2) for determination of blood lactate concentration and central venous oxygen saturation ( ScVO2 ).The changing rate of lactate ( (baseline lactate concentration-lactate concentration at 6 h of volume therapy) ÷ baseline value × 100％ ) and ScvO2 ( ( ScvO2 at 6 h of volume therapy - baseline ScvO2 ) ÷ baseline value × 100％ ) ) was calculated.Results The changing rate of lactate was significantly higher in Ⅱ group than in Ⅰ group.There was no significant difference in the changing rate of ScvO2 between the 2 groups.Conclusion Volume therapy guided by CVP and GEDVI can provide better tissue perfusion than by CVP alone in septic shock patients.
