中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2014年
12期
918-922
,共5页
陈容欣%张育才%崔云%缪惠洁%徐梁%戎群芳
陳容訢%張育纔%崔雲%繆惠潔%徐樑%戎群芳
진용흔%장육재%최운%무혜길%서량%융군방
脓毒性休克%动静脉血二氧化碳分压差%中心静脉血氧饱和度%血流动力学%病死率
膿毒性休剋%動靜脈血二氧化碳分壓差%中心靜脈血氧飽和度%血流動力學%病死率
농독성휴극%동정맥혈이양화탄분압차%중심정맥혈양포화도%혈류동역학%병사솔
Septic shock%Venous-arterial carbon dioxide difference%Central venous oxygen saturation%Hemodynamics%Mortality
目的 探讨动静脉血二氧化碳分压差[P(cv-a) CO2]在脓毒性休克患儿病情评估和预后判断中的价值.方法 前瞻性研究,选择2012年6月至2014年5月上海交通大学附属儿童医院重症医学科(PICU)收治的脓毒性休克患儿共48例,其中男36例(75.0％)、女12例(25.0％),平均年龄(31.9±24.5)个月.于早期进行液体复苏治疗达到中心静脉血氧饱和度(ScvO2)＞70％后,根据P (cv-a) CO2的水平分为高P(cv-a) CO2组[≥6 mmHg(1 mmHg=0.133 kPa)]和低P(cv-a) CO2(＜6 mmHg)组.以平均动脉压(MAP)、中心静脉压(CVP)、ScvO2、动脉血乳酸的变化等作为研究指标.比较两组间第3代小儿死亡危险评分(PRISMⅢ评分)和小儿危重病例评分(PCIS),24 h乳酸清除率,28 d病死率等指标.组间比较采用t检验或非参数秩和检验,方差分析及x2检验.结果 48例脓毒性休克早期容量复苏ScvO2＞70％的患儿中,高P(cv-a) CO2组17例(35.4％),低P(cv-a) CO2组31例(65.6％),两组患儿年龄、性别、PRISMⅢ评分和PCIS差异均无统计学意义(P均＞0.05),两组动脉血乳酸与P(cv-a) CO2值差异有统计学意义.低P(cv-a) CO2组病死率低于高P(cv-a) CO2组[11/17比32.3％(10/31),P＜0.05];容量复苏24 h后,低P(cv-a) CO2组动脉血乳酸低于高P(cv-a)CO2组[(2.0±1.3)比(2.7±1.2) mmol/L,P＜0.05],血管活性药物使用时间明显短[(16±14)比(44±21)h,P＜0.05];低P(cv-a) CO2组患儿24 h乳酸清除率高于高P(cv-a) CO2组[(31±10)％比(26±6)％,P ＜0.05].结论 脓毒性休克患儿容量复苏达ScvO2＞70％,P(cv-a) CO2可作为进一步的评估组织灌注状态的指标,P(cv-a) CO2≥6 mmHg者预后较差.
目的 探討動靜脈血二氧化碳分壓差[P(cv-a) CO2]在膿毒性休剋患兒病情評估和預後判斷中的價值.方法 前瞻性研究,選擇2012年6月至2014年5月上海交通大學附屬兒童醫院重癥醫學科(PICU)收治的膿毒性休剋患兒共48例,其中男36例(75.0％)、女12例(25.0％),平均年齡(31.9±24.5)箇月.于早期進行液體複囌治療達到中心靜脈血氧飽和度(ScvO2)＞70％後,根據P (cv-a) CO2的水平分為高P(cv-a) CO2組[≥6 mmHg(1 mmHg=0.133 kPa)]和低P(cv-a) CO2(＜6 mmHg)組.以平均動脈壓(MAP)、中心靜脈壓(CVP)、ScvO2、動脈血乳痠的變化等作為研究指標.比較兩組間第3代小兒死亡危險評分(PRISMⅢ評分)和小兒危重病例評分(PCIS),24 h乳痠清除率,28 d病死率等指標.組間比較採用t檢驗或非參數秩和檢驗,方差分析及x2檢驗.結果 48例膿毒性休剋早期容量複囌ScvO2＞70％的患兒中,高P(cv-a) CO2組17例(35.4％),低P(cv-a) CO2組31例(65.6％),兩組患兒年齡、性彆、PRISMⅢ評分和PCIS差異均無統計學意義(P均＞0.05),兩組動脈血乳痠與P(cv-a) CO2值差異有統計學意義.低P(cv-a) CO2組病死率低于高P(cv-a) CO2組[11/17比32.3％(10/31),P＜0.05];容量複囌24 h後,低P(cv-a) CO2組動脈血乳痠低于高P(cv-a)CO2組[(2.0±1.3)比(2.7±1.2) mmol/L,P＜0.05],血管活性藥物使用時間明顯短[(16±14)比(44±21)h,P＜0.05];低P(cv-a) CO2組患兒24 h乳痠清除率高于高P(cv-a) CO2組[(31±10)％比(26±6)％,P ＜0.05].結論 膿毒性休剋患兒容量複囌達ScvO2＞70％,P(cv-a) CO2可作為進一步的評估組織灌註狀態的指標,P(cv-a) CO2≥6 mmHg者預後較差.
목적 탐토동정맥혈이양화탄분압차[P(cv-a) CO2]재농독성휴극환인병정평고화예후판단중적개치.방법 전첨성연구,선택2012년6월지2014년5월상해교통대학부속인동의원중증의학과(PICU)수치적농독성휴극환인공48례,기중남36례(75.0％)、녀12례(25.0％),평균년령(31.9±24.5)개월.우조기진행액체복소치료체도중심정맥혈양포화도(ScvO2)＞70％후,근거P (cv-a) CO2적수평분위고P(cv-a) CO2조[≥6 mmHg(1 mmHg=0.133 kPa)]화저P(cv-a) CO2(＜6 mmHg)조.이평균동맥압(MAP)、중심정맥압(CVP)、ScvO2、동맥혈유산적변화등작위연구지표.비교량조간제3대소인사망위험평분(PRISMⅢ평분)화소인위중병례평분(PCIS),24 h유산청제솔,28 d병사솔등지표.조간비교채용t검험혹비삼수질화검험,방차분석급x2검험.결과 48례농독성휴극조기용량복소ScvO2＞70％적환인중,고P(cv-a) CO2조17례(35.4％),저P(cv-a) CO2조31례(65.6％),량조환인년령、성별、PRISMⅢ평분화PCIS차이균무통계학의의(P균＞0.05),량조동맥혈유산여P(cv-a) CO2치차이유통계학의의.저P(cv-a) CO2조병사솔저우고P(cv-a) CO2조[11/17비32.3％(10/31),P＜0.05];용량복소24 h후,저P(cv-a) CO2조동맥혈유산저우고P(cv-a)CO2조[(2.0±1.3)비(2.7±1.2) mmol/L,P＜0.05],혈관활성약물사용시간명현단[(16±14)비(44±21)h,P＜0.05];저P(cv-a) CO2조환인24 h유산청제솔고우고P(cv-a) CO2조[(31±10)％비(26±6)％,P ＜0.05].결론 농독성휴극환인용량복소체ScvO2＞70％,P(cv-a) CO2가작위진일보적평고조직관주상태적지표,P(cv-a) CO2≥6 mmHg자예후교차.
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 children with septic shock who already had central venous oxygen saturation (ScvO2) higher than 70％ after early resuscitation.Method In this prospective study,48 septic shock children seen in Shanghai Children's Hospital,Shanghai Jiao Tong University were enrolled from Jun 2012 to May 2014.36(75.0％)were male,12(25.0％) were female,the average age was(31.9 ± 24.5)months.The critically ill patients with septic shock were treated to achieve ScvO2 greater than 70％ depending on early goal-directed therapy(EGDT).All patients were divided into two groups,based on P (cv-a) CO2,low P (cv-a) CO2 group with P (cv-a) CO2 ＜ 6 mmHg (1 mmHg =0.133 kPa) and high P(cv-a) CO2 group with P(cv-a) CO2 ≥6 mmHg.The parameters of hemodynamics including mean blood pressure (MAP),heart rate (HR),central venous pressure (CVP),perfusionrelated parameters [ScvO2,P (cv-a) CO2,serum lactate (Lac),Lac clearance rate],pediatric critical illness score,PRISM Ⅲ score,and 28 days in-hospital mortality were recorded for all patients.Result Of the 48 cases with septic shock whose ScvO2 was higher than 70％,17 patients (35.4％) had high P(cv-a) CO2(≥6 mmHg) and 31 (65.6％) had lower P(cv-a)CO2 (＜ 6 mmHg).There were no significant differences between the 2 groups of patients in age,PRISM Ⅲ score and PCIS (P ＞ 0.05),but Lac and P(cv-a) CO2 values were significantly different (P ＜0.05).Low P(cv-a) CO2 group patients had lower 28 days mortality than high P (cv-a) CO2 group [11/17 vs.32.3％ (10/31),P ＜ 0.05]; 24 h after resuscitation,compared with high P(cv-a) CO2 group,low P (cv-a) CO2 group patients had lower Lac values [(2.0 ± 1.3) vs.(2.7 ± 1.2) mmol/L,P ＜0.05].Low P(cv-a) CO2 group patients had shorter duration of vasoactive drugs use [(16 ± 14) vs.(44 ± 21) h,P ＜ 0.05],24 h Lac clearance rate was significantly higher for low P(cv-a) CO2 group than for high P(cv-a) CO2 group[(31 ± 10)％ vs.(26 ± 6) ％,P ＜ 0.05].Conclusion When ScvO2 ＞ 70％ was achieved after early resuscitation in septic shock children,P(cv-a) CO2 is a sensitive biomarker to assess tissue perfusion,and high P(cv-a) CO2 group patients had poor outcome.
