CAJ | 학술논문

目的：比较检测乳酸清除率和中心静脉血氧饱和度(ScvO2)指导严重感染患者早期液体复苏的效果。方法选取2012年1月至2014年12月期间海口市第三人民医院和海南省农垦总局医院重症医学科收治的30例严重感染或感染性休克患者，随机分为对照组(A组)、ScvO2组(B组)和乳酸清除率组(C组)，每组10例。A组患者早期液体复苏期间给予常规基本监测，B组患者在A组基础上添加复苏指标ScvO2>70%，C组患者在A组基础上添加复苏指标乳酸清除率>10%，比较三组患者的治疗效果、治疗前后APACHEⅡ评分、住院时间和ICU滞留时间。结果三组患者多器官功能障碍综合征(MODS)的发生率及7 d死亡率比较差异均无统计学意义(P>0.05)；治疗前三组患者的APACHEⅡ评分差异无统计学意义(P>0.05)，治疗后B、C组患者的APACHEⅡ评分均明显高于A组，差异均有统计学意义(P<0.05)；三组患者的住院时间比较差异无统计学意义，但ICU滞留时间A组患者明显长于B、C组，差异均有统计学意义(P<0.05)。结论 ScvO2和乳酸清除率均可用于指导严重感染患者的早期液体复苏，均可作为预后的重要评估指标。
목적：비교검측유산청제솔화중심정맥혈양포화도(ScvO2)지도엄중감염환자조기액체복소적효과。방법선취2012년1월지2014년12월기간해구시제삼인민의원화해남성농은총국의원중증의학과수치적30례엄중감염혹감염성휴극환자，수궤분위대조조(A조)、ScvO2조(B조)화유산청제솔조(C조)，매조10례。A조환자조기액체복소기간급여상규기본감측，B조환자재A조기출상첨가복소지표ScvO2>70%，C조환자재A조기출상첨가복소지표유산청제솔>10%，비교삼조환자적치료효과、치료전후APACHEⅡ평분、주원시간화ICU체류시간。결과삼조환자다기관공능장애종합정(MODS)적발생솔급7 d사망솔비교차이균무통계학의의(P>0.05)；치료전삼조환자적APACHEⅡ평분차이무통계학의의(P>0.05)，치료후B、C조환자적APACHEⅡ평분균명현고우A조，차이균유통계학의의(P<0.05)；삼조환자적주원시간비교차이무통계학의의，단ICU체류시간A조환자명현장우B、C조，차이균유통계학의의(P<0.05)。결론 ScvO2화유산청제솔균가용우지도엄중감염환자적조기액체복소，균가작위예후적중요평고지표。
Objective To compare the effect of central venous oxygen saturation (ScvO2) and lactate clear-ance rate in providing guidance for early fluid resuscitation of patients with severe infection. Methods From January 2012 to December 2014, 30 patients with severe infection in the Third People's Hospital of Haikou City and Hainan Provincial Nongken General Hospital were randomly divided into control group (group A), ScvO2 group (group B) and lactate clearance rate group (group C), with 10 cases in each group. During the early fluid resuscitation, patients in group A received conventional basic monitoring, patients in group B additionally took ScvO2 as monitoring index (ScvO2>70%) on the basis of group A , and patients in group C additionally took lactate clearance rate as monitoring index (lac-tate clearance rate>10%) on the basis of group A. Clinical efficacy, APACHE Ⅱ score before and after treatment, length of hospital stay, and ICU retention time were compared between the three groups. Results The three groups showed no statistically significant difference in the incidence of multiple organ dysfunction syndrome (MODS) and 7-d mortality (P>0.05). APACHEⅡscores before treatment showed no statistically significant difference between the three groups (P>0.05), and the score after treatment was significantly higher in group B, C than group A (P<0.05). The length of hospital stay showed no statically significant difference between the three groups, but the ICU retention time was significantly longer in group A than group B, C (P<0.05). Conclusion ScvO2 and lactate clearance rate both has great clinical significance in guiding early fluid resuscitation for patients with severe infection, which can both serve as the important indexes for the evaluating prognosis.