中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2013年
1期
24-27
,共4页
碳酸氢钠%感染性休克%乳酸酸中毒%早期目标导向治疗%多器官功能障碍综合征%病死率
碳痠氫鈉%感染性休剋%乳痠痠中毒%早期目標導嚮治療%多器官功能障礙綜閤徵%病死率
탄산경납%감염성휴극%유산산중독%조기목표도향치료%다기관공능장애종합정%병사솔
Sodium bicarbonate%Septic shock%Lactic acidemia%Early goal-directed therapy%Multiple organ dysfunction syndrome%Mortality
目的 探讨分阶段应用碳酸氢钠对感染性休克致低灌注性乳酸酸中毒患者的效果.方法 采用前瞻性随机对照双盲研究,将2006年4月至2010年4月本院65例感染性休克致低灌注性乳酸酸中毒患者按随机数字表法分为碳酸氢钠分阶段治疗组(35例)和对照组(30例).两组均行早期目标导向治疗(EGDT),分阶段治疗组先静脉滴注(静滴)碳酸氢钠使pH值≥7.15,6h后再次静滴碳酸氢钠使pH值≥7.25；对照组静滴碳酸氢钠使pH值≥7.15.观察两组患者衰竭器官数、机械通气时间、最高序贯器官衰竭评分(SOFA)、SOFA评分差值、住重症监护病房(ICU)天数、住院天数、ICU病死率；分别于入院0h、8h测定患者血气分析和血流动力学指标.结果 与对照组比较,分阶段治疗组衰竭器官数(个)、机械通气时间(d)、最高SOFA评分(分)、SOFA评分差值(分)、住ICU天数(d)、住院天数(d)及ICU病死率均明显降低(衰竭器官数:2.68±0.79比3.28±0.80,机械通气时间:10.32±2.26比13.80±2.56,最高SOFA评分:11.01±2.26比13.11 ±2.26,SOFA评分差值:1.71±1.25比3.43±1.27,住ICU天数:14.0±3.6比20.0±3.7,住院天数:28.3±12.9比41.9±13.2,ICU病死率:34.28％比60.00％,P＜0.05或P＜0.01).两组入院0h时血气分析和血流动力学指标均无差异；8h时均有改善,与对照组比较,分阶段治疗组血乳酸(Lac,mmol/L)明显降低(1.50±1.08比2.93±1.09),pH值、混合静脉血氧饱和度(SvO2)、氧摄取率(O2ER)、心排血指数(CI,ml ·s-1 ·m-2)、氧供(DO2,ml·min-1·m-2)明显升高(pH值:7.29±0.05比7.20±0.05,SvO2:0.75±0.18比0.66±0.17,O2ER:0.32±0.06比0.25±0.06,CI:113.36±13.34比83.35±13.34,DO2:840±170比630±171,均P＜0.01).结论 感染性休克致低灌注性乳酸酸中毒患者分阶段使用碳酸氢钠可明显减少多器官功能衰竭的发生,缩短机械通气时间、住ICU时间及住院时间,降低病死率.
目的 探討分階段應用碳痠氫鈉對感染性休剋緻低灌註性乳痠痠中毒患者的效果.方法 採用前瞻性隨機對照雙盲研究,將2006年4月至2010年4月本院65例感染性休剋緻低灌註性乳痠痠中毒患者按隨機數字錶法分為碳痠氫鈉分階段治療組(35例)和對照組(30例).兩組均行早期目標導嚮治療(EGDT),分階段治療組先靜脈滴註(靜滴)碳痠氫鈉使pH值≥7.15,6h後再次靜滴碳痠氫鈉使pH值≥7.25；對照組靜滴碳痠氫鈉使pH值≥7.15.觀察兩組患者衰竭器官數、機械通氣時間、最高序貫器官衰竭評分(SOFA)、SOFA評分差值、住重癥鑑護病房(ICU)天數、住院天數、ICU病死率；分彆于入院0h、8h測定患者血氣分析和血流動力學指標.結果 與對照組比較,分階段治療組衰竭器官數(箇)、機械通氣時間(d)、最高SOFA評分(分)、SOFA評分差值(分)、住ICU天數(d)、住院天數(d)及ICU病死率均明顯降低(衰竭器官數:2.68±0.79比3.28±0.80,機械通氣時間:10.32±2.26比13.80±2.56,最高SOFA評分:11.01±2.26比13.11 ±2.26,SOFA評分差值:1.71±1.25比3.43±1.27,住ICU天數:14.0±3.6比20.0±3.7,住院天數:28.3±12.9比41.9±13.2,ICU病死率:34.28％比60.00％,P＜0.05或P＜0.01).兩組入院0h時血氣分析和血流動力學指標均無差異；8h時均有改善,與對照組比較,分階段治療組血乳痠(Lac,mmol/L)明顯降低(1.50±1.08比2.93±1.09),pH值、混閤靜脈血氧飽和度(SvO2)、氧攝取率(O2ER)、心排血指數(CI,ml ·s-1 ·m-2)、氧供(DO2,ml·min-1·m-2)明顯升高(pH值:7.29±0.05比7.20±0.05,SvO2:0.75±0.18比0.66±0.17,O2ER:0.32±0.06比0.25±0.06,CI:113.36±13.34比83.35±13.34,DO2:840±170比630±171,均P＜0.01).結論 感染性休剋緻低灌註性乳痠痠中毒患者分階段使用碳痠氫鈉可明顯減少多器官功能衰竭的髮生,縮短機械通氣時間、住ICU時間及住院時間,降低病死率.
목적 탐토분계단응용탄산경납대감염성휴극치저관주성유산산중독환자적효과.방법 채용전첨성수궤대조쌍맹연구,장2006년4월지2010년4월본원65례감염성휴극치저관주성유산산중독환자안수궤수자표법분위탄산경납분계단치료조(35례)화대조조(30례).량조균행조기목표도향치료(EGDT),분계단치료조선정맥적주(정적)탄산경납사pH치≥7.15,6h후재차정적탄산경납사pH치≥7.25；대조조정적탄산경납사pH치≥7.15.관찰량조환자쇠갈기관수、궤계통기시간、최고서관기관쇠갈평분(SOFA)、SOFA평분차치、주중증감호병방(ICU)천수、주원천수、ICU병사솔；분별우입원0h、8h측정환자혈기분석화혈류동역학지표.결과 여대조조비교,분계단치료조쇠갈기관수(개)、궤계통기시간(d)、최고SOFA평분(분)、SOFA평분차치(분)、주ICU천수(d)、주원천수(d)급ICU병사솔균명현강저(쇠갈기관수:2.68±0.79비3.28±0.80,궤계통기시간:10.32±2.26비13.80±2.56,최고SOFA평분:11.01±2.26비13.11 ±2.26,SOFA평분차치:1.71±1.25비3.43±1.27,주ICU천수:14.0±3.6비20.0±3.7,주원천수:28.3±12.9비41.9±13.2,ICU병사솔:34.28％비60.00％,P＜0.05혹P＜0.01).량조입원0h시혈기분석화혈류동역학지표균무차이；8h시균유개선,여대조조비교,분계단치료조혈유산(Lac,mmol/L)명현강저(1.50±1.08비2.93±1.09),pH치、혼합정맥혈양포화도(SvO2)、양섭취솔(O2ER)、심배혈지수(CI,ml ·s-1 ·m-2)、양공(DO2,ml·min-1·m-2)명현승고(pH치:7.29±0.05비7.20±0.05,SvO2:0.75±0.18비0.66±0.17,O2ER:0.32±0.06비0.25±0.06,CI:113.36±13.34비83.35±13.34,DO2:840±170비630±171,균P＜0.01).결론 감염성휴극치저관주성유산산중독환자분계단사용탄산경납가명현감소다기관공능쇠갈적발생,축단궤계통기시간、주ICU시간급주원시간,강저병사솔.
Objective To explore the use of sodium bicarbonate in stages in treating hypoperfusion induced lactic acidemia due to septic shock.Methods In this prospective randomized,double-blind,controlled clinical trial,a total of 65 patients of hypoperfusion induced lactic acidemia due to septic shock admitted between April 2006 and April 2010 were assigned to two groups.Thirty-five patients of "stage" group sodium bicarbonate was used in two stages:in first stage sodium bicarbonate was given by venous drip until pH ≥7.15,and in second stage sodium bicarbonate was given by intravenous drip till pH ≥7.25 after 6 hours.Thirty patients in control group intravenous drip of sodium bicarbonate was used till pH ≥7.15.Early goal-directed therapy (EGDT) was used in the first 6 hours of fluid resuscitation.The number of dysfunction organ,time of mechanical ventilation,maximum sequential organ failure assessment (SOFA) score,delta SOFA score,durations of stay in intensive care unit (ICU) and in hospital,and mortality were recorded in two groups.Blood gas analysis and index of hemodynamics were monitored at 0 hour and 8 hours in both groups.Results Compared with control group,"stage" group was associated with a lower number of dysfunction organ,time of mechanical ventilation (days),maximum SOFA score,delta SOFA score,durations of stay in ICU (days) and in hospital (days),and mortality (number of dysfunction organ:2.68 ± 0.79 vs.3.28 ± 0.80,time of mechanical ventilation:10.32 ± 2.26 vs.13.80 ± 2.56,maximum SOFA score:11.01 ± 2.26 vs.13.11 ± 2.26,delta SOFA score:1.71 ± 1.25 vs.3.43 ± 1.27,duration of stay in ICU:14.0 ±3.6 vs.20.0 ±3.7,duration of stay in hospital:28.3 ± 12.9 vs.41.9 ± 13.2,mortality:34.28％ vs.60.00％,P＜0.05 or P＜0.01).There were no significant differences in blood gas analysis and index of hemodynamics at 0 hour,and they were improved at 8 hours.Compared with control group,in "stage" group,lactic acid (Lac,mmol/L) was significantly lowered (1.50 ± 1.08 vs.2.93 ± 1.09),and pH,mixed venous oxygen saturation (SvO2),oxygen extraction ratio (O2ER),cardiac index (CI,ml ·s-1 ·m-2),oxygen delivery (DO2,ml ·min-1 ·m-2) were significantly increased (pH:7.29 ± 0.05 vs.7.20 ± 0.05,SvO2:0.75 ±0.18 vs.0.66 ±0.17,O2ER:0.32 ±0.06 vs.0.25 ±0.06,CI:113.36 ± 13.34 vs.83.35 ± 13.34,DO2:840 ± 170 vs.630 ± 171,all P＜0.01).Conclusion The use of sodium bicarbonate in stages in treating hypoperfusion induced lactic acidemia as a result of septic shock can lower the occurrence rate of multiple organ dysfunction syndrome,time of mechanical ventilation,durations of stay in ICU and in hospital,and mortality.
