中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2011年
11期
669-672
,共4页
王东浩%吕扬%夏睿%杨洋%刘坤彬%韩涛
王東浩%呂颺%夏睿%楊洋%劉坤彬%韓濤
왕동호%려양%하예%양양%류곤빈%한도
肿瘤%危重患者%血流动力学%中心静脉-动脉血二氧化碳分压差
腫瘤%危重患者%血流動力學%中心靜脈-動脈血二氧化碳分壓差
종류%위중환자%혈류동역학%중심정맥-동맥혈이양화탄분압차
Cancer%Critical ill patient%Hemodynamic%Central venous-to-arterial carbon dioxidedifference
目的 应用中心静脉-动脉血二氧化碳分压差(Pcv-aCO2)评估危重患者血流动力学状态并指导治疗.方法 回顾性选取本院重症监护病房(ICU)收治的47例血流动力学异常的肿瘤危重患者,按照指南规范治疗24 h,以早期目标导向治疗(EGDT)的标准作为治疗终点.按治疗前后序贯器官衰竭评分(SOFA评分)差值(△SOFA)分为△SOFA≤1组(27例)与△SOFA＞1组(20例),比较两组患者治疗前后平均动脉压(MAP)、每小时尿量、中心静脉压(CVP)、中心静脉血氧饱和度(ScvO2)、乳酸清除率、Pcv-aCO2等指标的差异及与△SOFA的相关性.结果 在接受治疗前,△SOFA≤1组与△SOFA＞1组MAP[mm Hg(1 mm Hg=0.133 kPa):54.48±4.95比54.45±4.30]、每小时尿量(ml:19.33±4.53比20.55±5.54)、CVP (mm Hg:3.48±1-81比3.25±1.16)、ScvO2 (0.571±0.042比0.578±0.047)比较差异均无统计学意义(均P＞0.05)；与△SOFA＞1组比较,△SOFA≤1组Pcv-aCO2 (mm Hg:7.80±2.20比9.39±0.97)、SOFA评分(分:6.33±2.11比9.50±1.24)显著降低(均P＜0.01).在容量复苏后24 h,△SOFA≤1组与△SOFA＞1组MAP(mm Hg:73.48±6.12比71.30±7.30)、CVP(mm Hg:6.85±1.26比6.50±1.28)、ScvO2(0.693±0.032比0.684±0.039)等指标均较治疗前有所改善,但两组间比较差异无统计学意义(均P＞0.05),而Pcv-aCO2(mm Hg:3.02±1.59比8.21±2.23)、每小时尿量(ml:71.41±6.74比51.70±7.50)、SOFA评分(分:6.03±2.56比10.05±1.61)、乳酸清除率[(27.71±11.46)％比-(0.78±13.29)％]差异均有统计学意义(均P＜0.01).两组患者每小时尿量及Pcv-aCO2、乳酸清除率与△SOFA均存在显著相关性(r值分别为-0.712、0.745、-0.631,均P＜0.05).结论 Pcv-aCO2可作为评估患者血流动力学状态的指标,也可作为评估治疗效果和预后的一项指标.
目的 應用中心靜脈-動脈血二氧化碳分壓差(Pcv-aCO2)評估危重患者血流動力學狀態併指導治療.方法 迴顧性選取本院重癥鑑護病房(ICU)收治的47例血流動力學異常的腫瘤危重患者,按照指南規範治療24 h,以早期目標導嚮治療(EGDT)的標準作為治療終點.按治療前後序貫器官衰竭評分(SOFA評分)差值(△SOFA)分為△SOFA≤1組(27例)與△SOFA＞1組(20例),比較兩組患者治療前後平均動脈壓(MAP)、每小時尿量、中心靜脈壓(CVP)、中心靜脈血氧飽和度(ScvO2)、乳痠清除率、Pcv-aCO2等指標的差異及與△SOFA的相關性.結果 在接受治療前,△SOFA≤1組與△SOFA＞1組MAP[mm Hg(1 mm Hg=0.133 kPa):54.48±4.95比54.45±4.30]、每小時尿量(ml:19.33±4.53比20.55±5.54)、CVP (mm Hg:3.48±1-81比3.25±1.16)、ScvO2 (0.571±0.042比0.578±0.047)比較差異均無統計學意義(均P＞0.05)；與△SOFA＞1組比較,△SOFA≤1組Pcv-aCO2 (mm Hg:7.80±2.20比9.39±0.97)、SOFA評分(分:6.33±2.11比9.50±1.24)顯著降低(均P＜0.01).在容量複囌後24 h,△SOFA≤1組與△SOFA＞1組MAP(mm Hg:73.48±6.12比71.30±7.30)、CVP(mm Hg:6.85±1.26比6.50±1.28)、ScvO2(0.693±0.032比0.684±0.039)等指標均較治療前有所改善,但兩組間比較差異無統計學意義(均P＞0.05),而Pcv-aCO2(mm Hg:3.02±1.59比8.21±2.23)、每小時尿量(ml:71.41±6.74比51.70±7.50)、SOFA評分(分:6.03±2.56比10.05±1.61)、乳痠清除率[(27.71±11.46)％比-(0.78±13.29)％]差異均有統計學意義(均P＜0.01).兩組患者每小時尿量及Pcv-aCO2、乳痠清除率與△SOFA均存在顯著相關性(r值分彆為-0.712、0.745、-0.631,均P＜0.05).結論 Pcv-aCO2可作為評估患者血流動力學狀態的指標,也可作為評估治療效果和預後的一項指標.
목적 응용중심정맥-동맥혈이양화탄분압차(Pcv-aCO2)평고위중환자혈류동역학상태병지도치료.방법 회고성선취본원중증감호병방(ICU)수치적47례혈류동역학이상적종류위중환자,안조지남규범치료24 h,이조기목표도향치료(EGDT)적표준작위치료종점.안치료전후서관기관쇠갈평분(SOFA평분)차치(△SOFA)분위△SOFA≤1조(27례)여△SOFA＞1조(20례),비교량조환자치료전후평균동맥압(MAP)、매소시뇨량、중심정맥압(CVP)、중심정맥혈양포화도(ScvO2)、유산청제솔、Pcv-aCO2등지표적차이급여△SOFA적상관성.결과 재접수치료전,△SOFA≤1조여△SOFA＞1조MAP[mm Hg(1 mm Hg=0.133 kPa):54.48±4.95비54.45±4.30]、매소시뇨량(ml:19.33±4.53비20.55±5.54)、CVP (mm Hg:3.48±1-81비3.25±1.16)、ScvO2 (0.571±0.042비0.578±0.047)비교차이균무통계학의의(균P＞0.05)；여△SOFA＞1조비교,△SOFA≤1조Pcv-aCO2 (mm Hg:7.80±2.20비9.39±0.97)、SOFA평분(분:6.33±2.11비9.50±1.24)현저강저(균P＜0.01).재용량복소후24 h,△SOFA≤1조여△SOFA＞1조MAP(mm Hg:73.48±6.12비71.30±7.30)、CVP(mm Hg:6.85±1.26비6.50±1.28)、ScvO2(0.693±0.032비0.684±0.039)등지표균교치료전유소개선,단량조간비교차이무통계학의의(균P＞0.05),이Pcv-aCO2(mm Hg:3.02±1.59비8.21±2.23)、매소시뇨량(ml:71.41±6.74비51.70±7.50)、SOFA평분(분:6.03±2.56비10.05±1.61)、유산청제솔[(27.71±11.46)％비-(0.78±13.29)％]차이균유통계학의의(균P＜0.01).량조환자매소시뇨량급Pcv-aCO2、유산청제솔여△SOFA균존재현저상관성(r치분별위-0.712、0.745、-0.631,균P＜0.05).결론 Pcv-aCO2가작위평고환자혈류동역학상태적지표,야가작위평고치료효과화예후적일항지표.
Objective To evaluate the hemodynamic state of critically ill cancer patients using central venous-to-arterial carbon dioxide difference (Pcv-aCO2) and to direct the treatment.Methods Clinical data of 47 cancer critically ill patients with acute physiology and chronic health evaluation Ⅰ (APACHE Ⅰ ) score ＞ 15 and unstable hemodynamic state were enrolled from intensive care unit of Tianjin Medical University Cancer Hospital from October 1st 2010 to May 31th 2011,were analyzed retrospectively.The patients were receiving the standard treatment according to the guidelines for 24 hours,the end-point of therapy was the standard of early goal direct therapy (EGDT).According to difference of sequential organ failure scores (△SOFA) of that after treatment and before treatment,the patients were divided into two groups:△SOFA≤ 1 (n=27) and △SOFA＞1 (n=20).The mean arterial pressure (MAP),urine output per hour,central venous pressure (CVP),oxygen saturation of central venous blood (ScvO2),the clearance of lactic acid,and Pcv-aCO2 before treatment were compared with those after treatment,and their correlation with △SOFA was analysed.Results There were no significant differences in MAP (mm Hg,1 mm Hg=0.133 kPa:54.48± 4.95 vs.54.45±4.30),urine output per hour (ml:19.33±4.53 vs.20.55±5.54),CVP(mm Hg:3.48± 1.81 vs.3.25±1.16),ScvO2(0.571±0.042 vs.0.578±0.047) of two groups before treatment (all P＞ 0.05),but in the group △SOFA≤1,the Pcv-aCO2(mm Hg:7.80±2.20 vs.9.39±0.97) and SOFA scores (6.33±2.11 vs.9.50±1.24) were significantly lower than those of the group △SOFA＞1 (all P＜0.01).There were no significant differences in MAP (mm Hg:73.48±6.12 vs.71.30±7.30),CVP (mm Hg:6.85±1.26 vs.6.50±1.28),ScvO2(0.693±0.032 vs.0.684±0.039) between two groups after treatment (all P＞0.05),though their results data were improved compared with that of before treatment.However,there were significant differences in Pcv-aCO2(mm Hg:3.02±1.59 vs.8.21±2.23),urine output per hour (ml:71.41±6.74 vs.51.70±7.50),SOFA score (6.03±2.56 vs.10.05±1.61),the clearance of lactic acid [(27.71 ±11.46) ％ vs.- (0.78±13.29) ％,all P＜0.01].There was significant correlation between urine output per hour,Pev-aCO2,clearance of lactic acid and △SOFA (r values were -0.712,0.745,-0.631,all P＜0.05).Conclusion Pcv-aCO2 could be used as an index of evaluating the cardiac index and the hemodynamic state,and it could be considered to be one of the indices of evaluating the therapeutic effect and prognosis.
