摘要
目的探讨动静脉血二氧化碳分压差[P（cv-a）CO2]判断感染性休克患者疾病严重程度与预后的价值。方法选取东南大学附属中大医院重症医学科的感染性休克患者45例，依据基线时P（cv-a）CO2水平将患者分为高P（cv-a）CO2组[P（cv-a）CO2≥6mmHg；1mmHg=0．133kPa]与低P（cv-a）CO2组[P（cv-a）CO2〈6mmHg]，入组后立即采用早期目标指导性治疗（EGDT），观察2组患者血流动力学及氧代谢、6hEGDT达标率、ICU病死率及28d病死率等。结果 与高P（cv-a）CO2组比，低P（cv-a）CO2组患者基线时心指数、氧输送（DO2）、中心静脉血氧饱和度及24h心指数、24hDO2较高，乳酸水平[（3．4±2．1）mmol/L比（5．7±4．5）mmol／L]较低（P〈0．05），24h序贯器官衰竭评估（SOFA）分值[（7．8±2．0）分比（9．8±2．0）分]显著下降（P〈0．05），△SOFA分值[（0．7±1．8）分比（－0．4±1．1）分]、6hEGDT达标率（83．3％比53．3％）较高（P〈0．05），2组患者ICU病死率及28d病死率差异无统计学意义（P〉0．05）。结论 P（cv-a）CO2是判断感染性休克患者组织灌注与疾病严重程度的具有重要意义的临床指标。
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 patients with septic shock. Methods There were 45 consecutive resuscitated septic shock patients from April 2009 to October 2010 included immediately after their admission into our ICU. The patients were divided into low P（cv-a）CO2 group and high P（cv-a）CO2 group according to a threshold of 6 mm Hg （1 mm Hg =0. 133 kPa）. All patients were treated by early goal directed therapy （EGDT）. The parameters of hemodynamies, lactate clearance rate, the Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ ） score, the sequential organ failure assessment （SOFA） score, 6 h rate of EGDT achievement, the ICU mortality and 28 days in-hospital mortality were recorded for all patients. Results There were 30 patients in the low P（cv-a）CO2 group, and 15 in the high P（cv-a） CO2 group. There were no significant differences between low P（cv-a）CO2 and high P（cv-a）CO2 patients in age, APACHE Ⅱ score and SOFA score （ all P 〉 0.05 ）. Compared with the high P（cv-a）CO2 group, the low P（cv-a）CO2 group had higher cardiac index （CI） and 24 h CI, higher delivery 02 （DO2 ） and 24 h DO2, higher central venous oxygen saturation（ ScvO2 ） [ （74 ± 9） % vs （67 ± 8 ） % ] , lower lactate [ （ 3.4 ±2. 1 ） mmol/L vs （ 5.7 ±g. 5 ） mmol/L] and higher ASOFA score [ （0. 7 ± 1.8 ） vs （ - 0. 4 ± 1.1 ） ], lower 24 h SOFA score [ （7.8 ±2.0） vs （9.8 ±2.0） ~, higher 6 h rate of EGDT achievement （83.3% vs 53.3% ） （P 〈 0. 05）, however, there were no differences in 28 days mortality and ICU mortality between the two groups （ P 〉 0. 05 ）. Conclusion P（cv-a）CO2 might be an indicator for predicting the severity of patients with septic shock and evaluating tissue perfusion.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2012年第6期437-440,共4页
Chinese Journal of Internal Medicine
