摘要
目的 探讨容量复苏并高容量血液滤过（HVHF）对难治性脓毒性休克患者肺泡-动脉间氧分压交换的影响.方法 选取2006年8月至2009年12月山东大学附属省立医院重症监护室89例难治性脓毒性休克患者,随机（随机数字法）分为容量复苏组（A组,41例）和容量复苏并HVHF组（B组,48例）,均完成72 h HVHF,比较两组治疗前后中心静脉氧含量（CcvO2）、桡动脉氧含量（CaO2）、肺泡氧分压与动脉氧分压的差值[P（A-a）DO2]、动脉/肺泡氧分压比值（PaO2/PAO2）、呼吸指数[RI=P（A-a）DO2/PaO2]、氧合指数[OI=PaO2/FiO2]及急性生理和慢性健康评分Ⅱ评分（APACHE Ⅱ）的变化.结果 ①治疗后7 d时,B组较A组CcvO2,CaO2改善,分别为（0.60±0.24）vs.（0.72±0.28）,P＜0.05,和（0.84±0.43）vs.（0.94±0.46）,P＜0.05;氧摄取率（O2ER）下降,（28.7±2.4）vs.（21.7±3.4）,P＜0.01,均具有统计学意义;②治疗后24 h,72 h,7 d 时,P（A-a）DO2,PaO2/PAO2比值,RI,OI差异具有统计学意义（P＜0.05或P＜0.01）;③治疗7 d时,B组的APACHE Ⅱ评分低于A组,差异有统计学意义[（17.2±6.8）vs.（8.2±3.8）,P＜0.01].结论 容量复苏并HVHF能改善难治性脓毒性休克患者肺泡-动脉间间氧交换,降低患者APACHE Ⅱ评分,改善预后.
Objective To evaluate the effects of fluid resuscitation and large-volume hemofiltration （HVHF） on the Alveolar-arterial oxygen exchange in patients with refractory septic shock. Method A total of 89 intensive care patients with refractory septic shock treated with fluid resuscitation and/or HVHF were enrolled between August 2006 and December 2009. All the patients were randomly divided into two groups. In group A, patients were treated with fluid resuscitation, n = 41 cases） and in group B, patients were treated with large-volume hemofiltration and fluid resuscitation, n =48）. The O2 content of central venous blood（CcvO2）, arterial oxygen content （CaO2）, Alveolar-arterial oxygen pressure difference （P（A-a）DO2）, the ratio of arterial oxygen pressure/alveolar oxygen pressure （PaO2/PAO2）, respiratory index （RI） and oxygenation index （OI） were checked. The levels of oxygen exchange in two groups were detected by arterial blood gas analysis before treatnent, 24 hour, 72 hour and 7 days after treatment. The APACHE Ⅱ scores in patients with refractory septic shock were measured before and the 7th day after treatment with HVHF and/or fluid resuscitation respectively. Data were analyzed by using t -test and chi-square test to compare the differences and ratio between two groups and were expressed in mean ± standard deviation, and the analysis of variance was done with SPSS version 12.0 software. Results ① The differences in CcvO2 and CaO2 between two groups were[（0.60±0.24） vs. （0.72±-0.28）, P 〈0.05 and （0.84±0.43） vs. （0.94±0.46）, P 〈0.05]; and the oxygen extraction rates （O2ER） were significantly different between two groups [（28.7±2.4） vs. （21.7±3.4）, P〈0.01];② The levels of P（A-a）DO2、ratio of PaO2/PAO2、RI and OI in group B were reduced more significantly than in group A （P〈0.05 or P〈0.01）;③The APACHE Ⅱ scores in both groups were gradually reduced after treatment for 7 days, and the APACHE Ⅱscore in group B on the
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2010年第12期1300-1303,共4页
Chinese Journal of Emergency Medicine
基金
山东省自然科学基金资助（Y2006C77）
关键词
容量复苏
高容量血液滤过
脓毒性休克
氧摄取率
肺泡-动脉间氧分压差值
动脉/肺泡氧分压比值
呼吸指数
氧合指数
急性生理和慢性健康健康评分
Fluid resuscitation
High-volume hemofiltration（HVHF）
Septic shock
Oxygen extraction rate （O2ER）
Alveolar-arterial-oxygen exchange
Ratio of PaO2/PAO2
Respiratory index （RI）
Oxygenation index （OI）
Acute physiology and chronic health evaluation Ⅱ（APACHEⅡ）
