摘要
目的探讨动静脉二氧化碳分压差[P(cv-a)CO2]对脓毒性休克患者液体复苏指导和预后评估的意义。方法选择安徽省第二人民医院重症医学科2016年1月~2019年6月收治的脓毒性休克患者97例,根据患者早期目标治疗(EGDT)6 h后是否达标,分为达标组和未达标组,观察对比两组患者入ICU时及治疗后6和24 h的各个指标。同时记录两组患者的机械通气时间、24 h入液量、住ICU时间及28 d病死率等情况,并对P(cv-a)CO2水平和中心静脉血氧饱和度(ScvO2)、乳酸清除率(LCR)、24 h液体入量的相关性进行分析。结果本研究达标组患者共58例,未达标组患者共39例,未达标组患者的ScvO2水平在治疗后6和24 h时均显著低于达标组,平均动脉压(MAP)水平在治疗后6 h也显著低于达标组,未达标组患者在治疗前、治疗后6和24 h时的P(cv-a)CO2水平均显著高于达标组患者,差异有统计学意义(P <0.05)。达标组患者的24 h液体入量、住ICU时间、机械通气时间以及28 d病死率均显著低于未达标组患者,差异有统计学意义(P <0.05)。经过相关性分析发现,脓毒性休克患者液体复苏24 h内的P(cv-a)CO2水平与ScvO2水平、LCR水平呈负线性相关,与患者的24 h液体入量呈正线性相关,差异具有统计学意义(P <0.05)。结论 P(cv-a)CO2能够有效评估患者液体复苏治疗中的恢复状态,反映组织的氧代谢和机体灌注情况,同时P(cv-a)CO2水平与ScvO2水平、液体入量及LRC水平均具有一定相关性,P(cv-a)CO2越高,需要复苏液体的量越多。
Objective To explore the significance of the differential pressure of arterial and venous carbon dioxide[P(cv-aCO2]in the guidance of fluid resuscitation and prognosis evaluation of septic shock patients.Methods 97 patients with septic shock admitted to the Department of critical medicine of our hospital from January 2016 to June 2019 were selected.According to whether the patients reached the standard after 6 hours of EGDT,all patients were divided into the standard group and the non standard group.The indexes of the two groups were observed and compared when they entered the ICU and 6 hours and 24 hours after treatment.At the same time,the mechanical ventilation time,24-hour liquid intake,ICU stay time and 28 day mortality of the two groups were recorded,and the correlation between P(cv-a)CO2 level and ScvO2,LCR,24-hour liquid intake was analyzed.Results In this study,there were 58 patients in the standard group and 39 patients in the non standard group.The ScvO2 level in the non standard group was significantly lower than that in the standard group at 6 h and 24 h after treatment,and the map level was also significantly lower than that in the standard group at 6 h after treatment.The P(cv-a)CO2,level in the non standard group before,6 h and 24 h after treatment was significantly higher than that in the standard group.In addition,the 24-hour liquid intake,ICU time,mechanical ventilation time and 28 day mortality of the patients in the standard group were significantly lower than those in the non standard group(P<0.05).After correlation analysis,it was found that the level of P(cv-a)CO2,within 24 hours of fluid resuscitation was negatively correlated with the level of ScvO2 and LCR,and positively correlated with the volume of fluid in 24 hours of patients with septic shock(P<0.05).Conclusion P(cv-a)CO2,can effectively evaluate the recovery state of patients in fluid resuscitation treatment,reflect the tissue oxygen metabolism and body perfusion.At the same time,the level of P(cv-a)CO2,has a certain correlation w
作者
王见斌
孟令胜
陆丽丽
孔德华
张泽华
Wang Jianbin;Meng Lingsheng;Lu Lili(Department of critical medicine,Anhui Second People's Hospital,Hefei 230041,China)
出处
《中华保健医学杂志》
2020年第3期180-183,共4页
Chinese Journal of Health Care and Medicine
关键词
脓毒性休克
液体复苏
动静脉二氧化碳分压差
Septic shock
Fluid resuscitation
Arteriovenous differential pressure of carbon dioxide
