中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
22期
55-58
,共4页
微循环%感染性休克%早期目标导向治疗%组织灌注%氧代谢
微循環%感染性休剋%早期目標導嚮治療%組織灌註%氧代謝
미순배%감염성휴극%조기목표도향치료%조직관주%양대사
Microcirculation%Septic shock%Early goal directed therapy%Tissue perfusion%Tissue oxygenation
目的 探讨早期目标导向治疗(EGDT)对感染性休克患者组织灌注、微循环和氧代谢的影响.方法 选取早期感染性休克(＜24 h)患者69例,按照EGDT流程对患者进行治疗,监测经皮氧分压(PtcO2)和经皮二氧化碳分压(PtcCO2),检测EGDT达标前后血流动力学、组织氧和舌下微循环变化,同时变量相关性采用Pearson相关分析.结果 与治疗前相比,EGDT治疗后PtcO2[(78.1±30.8) mmHg(1mmHg=0.133 kPa)比(62.8±24.1) mmHg]、组织氧合指数(PtcO2/FiO2)[(141.7±78.3) mmHg比(110.8±60.5) mmHg]显著增加,PtcCO2[(29.0±4.1) mmHg比(39.1±6.4)mmHg]和经皮-动脉二氧化碳分压差[(1.4±0.5) mmHg比(1.7±0.8) mmHg]显著降低,差异有统计学意义(P＜0.05).PtcO2、PtcO2/FiO2、PtcCO2与中心静脉血氧饱和度、乳酸、氧输送、氧耗比较差异均无统计学意义(P＞0.05).结论 EGDT能改善感染性休克患者局部组织灌注和微循环,感染性休克EGDT达标前后全身组织灌注的指标可能不能反映局部组织灌注.
目的 探討早期目標導嚮治療(EGDT)對感染性休剋患者組織灌註、微循環和氧代謝的影響.方法 選取早期感染性休剋(＜24 h)患者69例,按照EGDT流程對患者進行治療,鑑測經皮氧分壓(PtcO2)和經皮二氧化碳分壓(PtcCO2),檢測EGDT達標前後血流動力學、組織氧和舌下微循環變化,同時變量相關性採用Pearson相關分析.結果 與治療前相比,EGDT治療後PtcO2[(78.1±30.8) mmHg(1mmHg=0.133 kPa)比(62.8±24.1) mmHg]、組織氧閤指數(PtcO2/FiO2)[(141.7±78.3) mmHg比(110.8±60.5) mmHg]顯著增加,PtcCO2[(29.0±4.1) mmHg比(39.1±6.4)mmHg]和經皮-動脈二氧化碳分壓差[(1.4±0.5) mmHg比(1.7±0.8) mmHg]顯著降低,差異有統計學意義(P＜0.05).PtcO2、PtcO2/FiO2、PtcCO2與中心靜脈血氧飽和度、乳痠、氧輸送、氧耗比較差異均無統計學意義(P＞0.05).結論 EGDT能改善感染性休剋患者跼部組織灌註和微循環,感染性休剋EGDT達標前後全身組織灌註的指標可能不能反映跼部組織灌註.
목적 탐토조기목표도향치료(EGDT)대감염성휴극환자조직관주、미순배화양대사적영향.방법 선취조기감염성휴극(＜24 h)환자69례,안조EGDT류정대환자진행치료,감측경피양분압(PtcO2)화경피이양화탄분압(PtcCO2),검측EGDT체표전후혈류동역학、조직양화설하미순배변화,동시변량상관성채용Pearson상관분석.결과 여치료전상비,EGDT치료후PtcO2[(78.1±30.8) mmHg(1mmHg=0.133 kPa)비(62.8±24.1) mmHg]、조직양합지수(PtcO2/FiO2)[(141.7±78.3) mmHg비(110.8±60.5) mmHg]현저증가,PtcCO2[(29.0±4.1) mmHg비(39.1±6.4)mmHg]화경피-동맥이양화탄분압차[(1.4±0.5) mmHg비(1.7±0.8) mmHg]현저강저,차이유통계학의의(P＜0.05).PtcO2、PtcO2/FiO2、PtcCO2여중심정맥혈양포화도、유산、양수송、양모비교차이균무통계학의의(P＞0.05).결론 EGDT능개선감염성휴극환자국부조직관주화미순배,감염성휴극EGDT체표전후전신조직관주적지표가능불능반영국부조직관주.
Objective To observe the effect of early goal directed therapy (EGDT) on tissue perfusion,microcirculation and oxygen metabolism in patients with septic shock.Methods A prospective observational study was carried out in 69 patients with early septic shock within 24 hours.The eligible patients were treated with the standard procedure of EGDT.The partial pressure of transcutaneous oxygen (PtcO2) and transcutaneous carbon dioxide (PtcCO2) was monitored and the changes of hemodynamic data,tissue oxygen,microcirculation before and after reaching the criteria of EGDT were recorded.Results Compared with that before treatment,PtcO2,tissue oxygenation index (PtcO2/FiO2) after EGDT was increased [(78.1 ± 30.8) mmHg (1 mmHg =0.133 kPa) vs.(62.8 ± 24.1) mmHg and (141.7 ± 78.3) mmHg vs.(110.8 ± 60.5) mmHg],PtcCO2 and percutaneous arterial carbon dioxide partial pressure difference was decreased[(29.0 ±4.1) mmHg vs.(39.1 ±6.4) mmHg and (1.4 ±0.5) mmHg vs.(1.7 ±0.8) mmHg],there was significant difference(P＜ 0.05).There was no significant difference in PtcO2,PtcO2/FiO2,PtcCO2,central venous blood oxygen saturation,lactic acid,oxygen and oxygen consumption (P ＞ 0.05).Conclusion EGDT can improve local tissue perfusion and microcirculation in patients with septic shock,body tissue perfusion index before and after EGDT may not be able to reflect the local tissue perfusion.
