CAJ | 학술논문

目的探讨动静脉血二氧化碳分压差[P(cv-a)CO2]判断感染性休克患者疾病严重程度与预后的价值.方法选取东南大学附属中大医院重症医学科的感染性休克患者45例,依据基线时P(cv-a) CO2水平将患者分为高P(cv-a)CO2组[P(cv-a)CO2≥6 mm Hg;1 mm Hg=0.133 kPa]与低P(cv-a)CO2组[P(cv-a)CO2 ＜6 mm Hg],入组后立即采用早期目标指导性治疗(EGDT),观察2组患者血流动力学及氧代谢、6hEGDT达标率、ICU病死率及28 d病死率等.结果与高P(cv-a)CO2组比,低P(cv-a)CO2组患者基线时心指数、氧输送( DO2)、中心静脉血氧饱和度及24h心指数、24 h DO2较高,乳酸水平[ (3.4±2.1) mmol/L比(5.7±4.5)mmol/L]较低(P＜0.05),24h序贯器官衰竭评估(SOFA)分值[(7.8±2.0)分比(9.8±2.0)分]显著下降(P＜0.05),△SOFA分值[(0.7±1.8)分比(-0.4±1.1)分]、6 h EGDT达标率(83.3％比53.3％)较高(P＜0.05),2组患者ICU病死率及28 d病死率差异无统计学意义(P＞0.05).结论 P(cv-a)CO2是判断感染性休克患者组织灌注与疾病严重程度的具有重要意义的临床指标.
목적 탐토동정맥혈이양화탄분압차[P(cv-a)CO2]판단감염성휴극환자질병엄중정도여예후적개치.방법 선취동남대학부속중대의원중증의학과적감염성휴극환자45례,의거기선시P(cv-a) CO2수평장환자분위고P(cv-a)CO2조[P(cv-a)CO2≥6 mm Hg;1 mm Hg=0.133 kPa]여저P(cv-a)CO2조[P(cv-a)CO2 ＜6 mm Hg],입조후립즉채용조기목표지도성치료(EGDT),관찰2조환자혈류동역학급양대사、6hEGDT체표솔、ICU병사솔급28 d병사솔등.결과 여고P(cv-a)CO2조비,저P(cv-a)CO2조환자기선시심지수、양수송( DO2)、중심정맥혈양포화도급24h심지수、24 h DO2교고,유산수평[ (3.4±2.1) mmol/L비(5.7±4.5)mmol/L]교저(P＜0.05),24h서관기관쇠갈평고(SOFA)분치[(7.8±2.0)분비(9.8±2.0)분]현저하강(P＜0.05),△SOFA분치[(0.7±1.8)분비(-0.4±1.1)분]、6 h EGDT체표솔(83.3％비53.3％)교고(P＜0.05),2조환자ICU병사솔급28 d병사솔차이무통계학의의(P＞0.05).결론 P(cv-a)CO2시판단감염성휴극환자조직관주여질병엄중정도적구유중요의의적림상지표.
Objective To assess the value of central venous-to-arterial carbon dioxide difference [ P( cv-a) CO2 ] in evaluation of disease severity and prognosis in patients with septic shock.Methods There were 45 consecutive resuscitated septic shock patients from April 2009 to October 2010 included immediately after their admission into our ICU.The patients were divided into low P(cv-a) CO2 group and high P(cv-a) CO2 group according to a threshold of 6 mm Hg ( 1 mm Hg=0.133 kPa).All patients were treated by early goal directed therapy (EGDT).The parameters of hemodynamics,lactate clearance rate,the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ ) score,the sequential organ failure assessment (SOFA)score,6 h rate of EGDT achievement,the ICU mortality and 28 days in-hospital mortality were recorded for all patients.Results There were 30 patients in the low P(cv-a) CO2 group,and 15 in the high P(cv-a)CO2group.There were no significant differences between low P(cv-a) CO2 and high P(cv-a) CO2 patients in age,APACHE Ⅱ score and SOFA score (all P ＞ 0.05 ).Compared with the high P(cv-a)CO2 group,the low P(cv-a) CO2 group had higher cardiac index ( CI ) and 24 h CI,higher delivery O2 ( DO2 ) and 24 h DO2,higher central venous oxygen saturation ( ScvO2 ) [ (74 ± 9) ％ vs (67 ± 8) ％ ],lower lactate [ ( 3.4 ± 2.1 )mmol/L vs (5.7 ± 4.5 ) mmol/L] and higher △SOFA score [ (0.7 ± 1.8 ) vs ( - 0.4 ± 1.1 ) ],lower 24 h SOFA score [ (7.8 ± 2.0) vs (9.8 ± 2.0 ) ],higher 6 h rate of EGDT achievement ( 83.3％ vs 53.3 ％ )(P ＜ 0.05 ),however,there were no differences in 28 days mortality and ICU mortality between the two groups ( P ＞ 0.05 ).Conclusion P(cv-a) CO2 might be an indicator for predicting the severity of patients with septic shock and evaluating tissue perfusion.