摘要
目的 探求全身血管阻力指数与血乳酸在早期脓毒性休克患者中的应用.方法 回顾性分析2011年9月～2013年6月温州市中心医院综合ICU病房收治的脓毒性休克患者60例,根据患者14 d后生存情况分为死亡组（n=22）及存活组（n=38）;分别记录患者入院时和24 h内血乳酸、全身血管阻力指数（SVRI）,计算6h或12h乳酸清除率[（初始乳酸-6 h或12h乳酸）/初始乳酸×100％]和入院后第14d的生存状态.结果 入院时两组患者血乳酸值明显高于正常值,但二者差异无统计学意义;6h后死亡组血乳酸值明显高于存活组,差异有统计学意义,P ＜0.05;给予液体复苏后早期两组患者的血乳酸均开始下降,但液体复苏后不同时间点测量的死亡组动脉血乳酸明显高于存活组,差异有统计学意义,P ＜0.05.入院时两组患者的SVRI明显下降,随着液体复苏的进行,SVRI上升.结论 脓毒性休克早期患者大多存在低血管阻力,在PiCCO的指导下,监测SVRI和血乳酸的变化,进行恰当精确的液体复苏,降低乳酸,改善全身血管阻力,可提高患者的生存率提高患者的生存率.
Objective To explore application of systemic vascular resistance index and blood lactic acid on early septic shock. Methods A retrospective analysis was performed on 60 patients with septic shock which admitted at the ICU in between September 2011 and June 2013. They were divided into two groups based on 14-day survival rate, survival group of 38, and death group of 22. 24-hour blood lactic acid, systemic vascular resistance index （SVRI）, calculate at 6-hour or 12-hour lactate clearance rate [（the initial lactic acid-6-h or 12-h lactic acid）/initial × 100%] lactate and 14-day after admission were observed. Results Blood lactic acid level of both two groups were significantly higher than normal, however, no statistical difference was found between the two groups; 6 hours after admission the blood lactic acid level of death group was significantly higher than the survival group, carrying out a statistical significance, P 〈0.05; After given the resuscitation fluid, both groups＇ blood lactic acid began to decline. Yet, death group＇ s arterial blood lactic acid level at different measurement point were always higher than survival group with a statistical meaning, P 〈0.05. At admission, it reflected a declined SVRI of both groups. After given resuscitation fluid, both groups＇ SVRI rise. Conclusions Most patients with septic shock on early stage were found low vascular resistance. Guided by PiCCO, monitoring SVRI and changes on blood lactic acid, and giving appropriately accurate resuscitation fluid which are considered being effective in reducing lactic acid and improving the systemic vascular resistance. It may result in improving the survival rate.
出处
《中国急救复苏与灾害医学杂志》
2014年第5期419-421,共3页
China Journal of Emergency Resuscitation and Disaster Medicine
关键词
脓毒性休克
全身血管阻力指数
乳酸
乳酸清除率
PICCO
生存率
Septic shock
systemic vascular resistance index
lactic acid
lactate clearance rate
PiCCO
survival rate
