中国急救医学
中國急救醫學
중국급구의학
Chinese Journal of Critical Care Medicine
2015年
10期
954-958
,共5页
王媛媛%苏美仙%刘欧亚%黄青青%万林骏%万晓红%黄云龙
王媛媛%囌美仙%劉歐亞%黃青青%萬林駿%萬曉紅%黃雲龍
왕원원%소미선%류구아%황청청%만림준%만효홍%황운룡
感染性休克%中心静脉血氧饱和度%中心静脉-动脉血二氧化碳分压差%乳酸清除率
感染性休剋%中心靜脈血氧飽和度%中心靜脈-動脈血二氧化碳分壓差%乳痠清除率
감염성휴극%중심정맥혈양포화도%중심정맥-동맥혈이양화탄분압차%유산청제솔
Septic shock%Central venous oxygen saturation%Central venous -arterial carbon dioxide%Lactate clearance
目的：探讨通过监测ScvO2与Pcv－aCO2能否更好地指导外科感染性休克患者早期液体复苏治疗。方法外科术后感染性休克患者46例，根据6 h复苏前后动脉及上腔静脉血气变化，分析ScvO2、Pcv－aCO2与Lac、BE及CO的相关性。依照预后分为生存组和死亡组，比较两组的ScvO2、Pcv－aCO2。按ScvO2与Pcv－aCO2分组，比较乳酸清除率、机械通气时间、住ICU时间及28 d病死率。结果 ScvO2、Pcv－aCO2与Lac、BE有部分相关性，与CO有相关性。 T0、T6的ScvO2与Pcv－aCO2呈负相关。依据预后分组，经过6 h复苏后生存组的Pcv－aCO2优于死亡组，但ScvO2比较差异无统计学意义。6 h复苏后ScvO2＞70％组内根据Pcv－aCO2是否达标分组，组间6 h乳酸清除率、28 d病死率比较差异有统计学意义（P＝0.018，P＝0．001）。6 h复苏后Pcv－aCO2＜6 mm Hg组内根据ScvO2是否达标分组，组间6 h乳酸清除率比较差异亦有统计学意义（P＝0．024）。经6 h复苏后Pcv－aCO2对预后具有中等判断能力（AUROC＝0．758）。将入选患者经6 h复苏后的ScvO2分为低ScvO2组（＜70％）、中ScvO2组（70％～80％）和高ScvO2组（＞80％），三组28 d病死率比较差异无统计学意义（P＝0.070）。结论 ScvO2与Pcv－aCO2均可作为外科感染性休克早期评价复苏疗效的有效指标，两者均达标的患者6 h乳酸清除率最高。但ScvO2达标Pcv－aCO2≥6 mm Hg时，提示复苏不充分。联合ScvO2与Pcv－aCO2更有利于指导感染性休克的复苏治疗。
目的：探討通過鑑測ScvO2與Pcv－aCO2能否更好地指導外科感染性休剋患者早期液體複囌治療。方法外科術後感染性休剋患者46例，根據6 h複囌前後動脈及上腔靜脈血氣變化，分析ScvO2、Pcv－aCO2與Lac、BE及CO的相關性。依照預後分為生存組和死亡組，比較兩組的ScvO2、Pcv－aCO2。按ScvO2與Pcv－aCO2分組，比較乳痠清除率、機械通氣時間、住ICU時間及28 d病死率。結果 ScvO2、Pcv－aCO2與Lac、BE有部分相關性，與CO有相關性。 T0、T6的ScvO2與Pcv－aCO2呈負相關。依據預後分組，經過6 h複囌後生存組的Pcv－aCO2優于死亡組，但ScvO2比較差異無統計學意義。6 h複囌後ScvO2＞70％組內根據Pcv－aCO2是否達標分組，組間6 h乳痠清除率、28 d病死率比較差異有統計學意義（P＝0.018，P＝0．001）。6 h複囌後Pcv－aCO2＜6 mm Hg組內根據ScvO2是否達標分組，組間6 h乳痠清除率比較差異亦有統計學意義（P＝0．024）。經6 h複囌後Pcv－aCO2對預後具有中等判斷能力（AUROC＝0．758）。將入選患者經6 h複囌後的ScvO2分為低ScvO2組（＜70％）、中ScvO2組（70％～80％）和高ScvO2組（＞80％），三組28 d病死率比較差異無統計學意義（P＝0.070）。結論 ScvO2與Pcv－aCO2均可作為外科感染性休剋早期評價複囌療效的有效指標，兩者均達標的患者6 h乳痠清除率最高。但ScvO2達標Pcv－aCO2≥6 mm Hg時，提示複囌不充分。聯閤ScvO2與Pcv－aCO2更有利于指導感染性休剋的複囌治療。
목적：탐토통과감측ScvO2여Pcv－aCO2능부경호지지도외과감염성휴극환자조기액체복소치료。방법외과술후감염성휴극환자46례，근거6 h복소전후동맥급상강정맥혈기변화，분석ScvO2、Pcv－aCO2여Lac、BE급CO적상관성。의조예후분위생존조화사망조，비교량조적ScvO2、Pcv－aCO2。안ScvO2여Pcv－aCO2분조，비교유산청제솔、궤계통기시간、주ICU시간급28 d병사솔。결과 ScvO2、Pcv－aCO2여Lac、BE유부분상관성，여CO유상관성。 T0、T6적ScvO2여Pcv－aCO2정부상관。의거예후분조，경과6 h복소후생존조적Pcv－aCO2우우사망조，단ScvO2비교차이무통계학의의。6 h복소후ScvO2＞70％조내근거Pcv－aCO2시부체표분조，조간6 h유산청제솔、28 d병사솔비교차이유통계학의의（P＝0.018，P＝0．001）。6 h복소후Pcv－aCO2＜6 mm Hg조내근거ScvO2시부체표분조，조간6 h유산청제솔비교차이역유통계학의의（P＝0．024）。경6 h복소후Pcv－aCO2대예후구유중등판단능력（AUROC＝0．758）。장입선환자경6 h복소후적ScvO2분위저ScvO2조（＜70％）、중ScvO2조（70％～80％）화고ScvO2조（＞80％），삼조28 d병사솔비교차이무통계학의의（P＝0.070）。결론 ScvO2여Pcv－aCO2균가작위외과감염성휴극조기평개복소료효적유효지표，량자균체표적환자6 h유산청제솔최고。단ScvO2체표Pcv－aCO2≥6 mm Hg시，제시복소불충분。연합ScvO2여Pcv－aCO2경유리우지도감염성휴극적복소치료。
Objective To determine whether central venous -to -arterial carbon dioxide P(cv-aCO2) and central venous oxygen saturation (ScvO2) could be sufficient guides early during fluid resuscitation in surgical septic shock patients .Methods Forty six postoperative septic shock patients were surveyed in this study .According to artery and superior vena cava blood gas , during both the beginning of resuscitation (T0) and in the 6th hour of resuscitation (T6), the correlation of cardiac output between ScvO 2 , Pcv -aCO2 and lactic acid, Base excess could be determined .Patients were divided into survival group and terminal group by the prognosis .Then, ScvO2 and Pcv -aCO2 levels were determine and compared between groups .Then they were divided into groups according to ScvO 2 and Pcv-aCO2 , and compared lactate clearance rate , mechanical ventilation time , ICU stay and 28-day mortality.Results There was a moderate correlation among ScvO 2, Pcv-aCO2 and lactic acid, Base excess , and there was a strong correlation between ScvO 2 , Pcv-aCO2 and cardiac output .Patients were divided into survival group and terminal group by the prognosis . After continuous 6 hour resuscitation, there was significant differences in the amount Pcv -aCO2 between the two groups , but there was no significant difference in the amount ScvO 2 .All enrolled patients who had ScvO 2 were greater than 70%after 6 hour resuscitation , they were divided into two groups , based on whether the patients'T6 Pcv-aCO2 was less than 6 mm Hg ( low gap group ) or greater than or equal to 6 mmHg ( high gap group ) .There was significant difference in the clearance of lactate and 28 d mortality ( P=0.018,P=0.001).All enrolled patients who had Pcv -aCO2 less than 6 mm Hg after 6 hour resuscitation were divided into two groups , based on whether the patients'T6 ScvO2 was less than 70%(low gap group) or greater than or equal to 70%(high gap group).There were significant differences in the clearance of lactate ( P =0.024 ).T6 Pcv -aCO2 concentration also helped prognostic ability (AUROC=0.758).All enrolled patients were divided into lower ScvO 2 group ( <70%), middle ScvO2 group (70%to 80%), and higher ScvO2 group ( >80%) after 6 hour resuscitation, there was no significant difference in 28 d mortality (χ2 Value =5.319, P =0.070 ).Conclusion The combination of ScvO2 and Pcv-aCO2 may guide the shock resuscitation .The clearance of lactate was the highest in the group of patients achieving the goals of both ScvO 2 >70% and Pcv-aCO2 <6 mm Hg. Septic patients targeting only ScvO 2 may still have inappropriate tissue perfusion , especially when Pcv-aCO2≥6 mm Hg, which indicates insufficient resuscitation .Combined ScvO 2 and Pcv-aCO2 to guide resuscitation of septic shock could be better affect the patient's prognosis .
