CAJ | 학술논문

目的探讨静动脉二氧化碳分压差( central venous-to-arterial carbon dioxide difference, Pcv-aCO2 )在脓毒性休克患者预后判断中的价值,及其联合中心静脉血氧饱和度( central venous oxygen saturation, ScvO2 )检测在该类患者液体复苏中的指导作用. 方法选取2011年3月-2013年12月我院重症医学二科住院的脓毒性休克患者98例,根据早期目标指导性治疗原则进行液体复苏,观察所有患者液体复苏前、复苏6 h时心率、平均动脉压( MAP)、中心静脉压( CVP)、ScvO2、乳酸、Pcv-aCO2 水平. 治疗28 d后根据患者是否存活分为死亡组和存活组,比较两组复苏6 h时急性生理学与慢性健康评定标准Ⅱ( APACHEⅡ)评分、乳酸清除率、ScvO2、Pcv-aCO2 水平. 根据复苏6 h时Pcv-aCO2是否≥6 mmHg分为高Pcv-aCO2 组和低Pcv-aCO2 组,比较两组APACHEⅡ评分、6 h乳酸清除率、ScvO2 及病死率. 分析复苏6 h时ScvO2≥0. 70的患者Pcv-aCO2 与乳酸清除率的相关性. 结果与液体复苏前比较,复苏6 h时98例患者MAP、ScvO2 增高,乳酸、Pcv-aCO2 降低,差异有统计学意义(P<0. 05或P<0. 01). 复苏6 h时,死亡组APACHEⅡ评分、Pcv-aCO2 明显高于存活组,乳酸清除率、ScvO2 低于存活组,差异均有统计学意义(P<0. 05或P<0. 01). 复苏6 h时高Pcv-aCO2 组病死率明显高于低Pcv-aCO2 组(P<0. 05),乳酸清除率明显低于低Pcv-aCO2 组(P<0. 05或P<0. 01). 复苏6 h时ScvO2≥0. 70的患者中Pcv-aCO2≥6 mmHg者乳酸清除率低于Pcv-aCO2 <6 mmHg者乳酸清除率的差异有统计学意义(t=1. 798,P=0. 049),且二者呈明显负相关(r= -0. 846,P=0. 000). 结论 Pcv-aCO2 可作为评估脓毒性休克患者预后的指标,Pcv-aCO2 联合ScvO2 检测在脓毒性休克患者液体复苏中具有重要的指导作用,可避免ScvO2 假性正常.
목적 탐토정동맥이양화탄분압차( central venous-to-arterial carbon dioxide difference, Pcv-aCO2 )재농독성휴극환자예후판단중적개치,급기연합중심정맥혈양포화도( central venous oxygen saturation, ScvO2 )검측재해류환자액체복소중적지도작용. 방법 선취2011년3월-2013년12월아원중증의학이과주원적농독성휴극환자98례,근거조기목표지도성치료원칙진행액체복소,관찰소유환자액체복소전、복소6 h시심솔、평균동맥압( MAP)、중심정맥압( CVP)、ScvO2、유산、Pcv-aCO2 수평. 치료28 d후근거환자시부존활분위사망조화존활조,비교량조복소6 h시급성생이학여만성건강평정표준Ⅱ( APACHEⅡ)평분、유산청제솔、ScvO2、Pcv-aCO2 수평. 근거복소6 h시Pcv-aCO2시부≥6 mmHg분위고Pcv-aCO2 조화저Pcv-aCO2 조,비교량조APACHEⅡ평분、6 h유산청제솔、ScvO2 급병사솔. 분석복소6 h시ScvO2≥0. 70적환자Pcv-aCO2 여유산청제솔적상관성. 결과 여액체복소전비교,복소6 h시98례환자MAP、ScvO2 증고,유산、Pcv-aCO2 강저,차이유통계학의의(P<0. 05혹P<0. 01). 복소6 h시,사망조APACHEⅡ평분、Pcv-aCO2 명현고우존활조,유산청제솔、ScvO2 저우존활조,차이균유통계학의의(P<0. 05혹P<0. 01). 복소6 h시고Pcv-aCO2 조병사솔명현고우저Pcv-aCO2 조(P<0. 05),유산청제솔명현저우저Pcv-aCO2 조(P<0. 05혹P<0. 01). 복소6 h시ScvO2≥0. 70적환자중Pcv-aCO2≥6 mmHg자유산청제솔저우Pcv-aCO2 <6 mmHg자유산청제솔적차이유통계학의의(t=1. 798,P=0. 049),차이자정명현부상관(r= -0. 846,P=0. 000). 결론 Pcv-aCO2 가작위평고농독성휴극환자예후적지표,Pcv-aCO2 연합ScvO2 검측재농독성휴극환자액체복소중구유중요적지도작용,가피면ScvO2 가성정상.
Objective To investigate the value of central venous-arterial carbon dioxide difference ( Pcv-aCO2 ) in evaluating the prognosis and the guiding effect on fluid resuscitation by Pcv-aCO2 combined with central venous oxygen saturation ( ScvO2 ) in detection of patients with septic shock. Methods A total of 98 patients with septic shock admitted during March 2011 to December 2013 underwent fluid resuscitation according to early goal directed therapy ( EGDT ) principle. The levels of heart rate ( HR) , mean arterial pressure ( MAP) , central venous pressure ( CVP) , ScvO2 , lac-tic acid and Pcv-aCO2 of all patients before and 6 h after the fluid resuscitation were detected. The patients were divided into survival group and death group after treatment for 28 d, and the acute physiology and chronic health evaluation II ( A-PACHE II) score, lactate clearance rate and ScvO2 , and Pcv-aCO2 levels at 6 h after the resuscitation in the two groups were compared. The patients were again divided into high Pcv-aCO2 group ( Pcv-aCO2≥6 mmHg) and low Pcv-aCO2 group ( Pcv-aCO2 <6 mmHg) according to Pcv-aCO2 value at 6 h after the resuscitation, and APACHE II score, lactate clearance rate, ScvO2 and fatality rate in the two groups were also compared. The correlation between Pcv-aCO2 value and lactate clearance rate was analyzed for patients whose ScvO2 value was greater than or equal to 0. 70 at 6 h after the resus-citation. Results Compared with those before liquid resuscitation, at 6 h after the resuscitation, MAP and ScvO2 values were increased, while the levels of lactic acid and Pcv-aCO2 were decreased in the 98 patients, and the differences were statistically significant (P<0. 05 or P<0. 01). At 6 h after the resuscitation, in the death group, APACHE II score and Pcv-aCO2 value were significantly higher, while the lactate clearance rate and ScvO2 value were significantly lower than those in the survival group, and the differences were statistically significant (P<0. 05 or P<0. 01). In high Pcv-aCO2 group, the mortality rate was significantly higher (P<0. 05), while the lactate clearance rate was significantly lower than those in the low Pcv-aCO2 group at 6 h after the resuscitation (P<0. 05 or P<0. 01). At 6 h after the resuscitation in the patients whose ScvO2 value was more than or equal to 0. 70, the lactate clearance rate in patients whose Pcv-aCO2 was more than or equal to 6 mmHg was lower than that in patients whose Pcv-aCO2 was less than 6 mmHg, and the difference was statistically significant (t=1. 798, P=0. 049), and the significantly negative correlation was found (r= -0. 846, P=0. 000). Conclusion The Pcv-aCO2 level can be used as an index for evaluating the prognosis of patients with sep-tic shock, the detection of Pcv-aCO2 combined with ScvO2 can guide the fluid resuscitation, and it also may avoid the in-adequately evaluation of ScvO2 .