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    程书立. 中心静脉-动脉二氧化碳分压差/动脉-中心静脉氧含量差在感染性休克患者复苏中应用[J]. 徐州医科大学学报, 2020, 40(7): 524-527.
    引用本文: 程书立. 中心静脉-动脉二氧化碳分压差/动脉-中心静脉氧含量差在感染性休克患者复苏中应用[J]. 徐州医科大学学报, 2020, 40(7): 524-527.
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    Application of P (cv-a) CO2 /C(a-cv)O2 ratio in fluid resuscitation of patients with septic shock[J]. Journal of Xuzhou Medical University, 2020, 40(7): 524-527.
    Citation: Application of P (cv-a) CO2 /C(a-cv)O2 ratio in fluid resuscitation of patients with septic shock[J]. Journal of Xuzhou Medical University, 2020, 40(7): 524-527.
    shu

    中心静脉-动脉二氧化碳分压差/动脉-中心静脉氧含量差在感染性休克患者复苏中应用

    Application of P (cv-a) CO2 /C(a-cv)O2 ratio in fluid resuscitation of patients with septic shock

      摘要
    • 摘要: 目的 评估中心静脉-动脉二氧化碳分压差/动脉-中心静脉氧含量差P (cv-a) CO2 /C(a-cv)O2在感染性休克患者复苏中的价值。方法 将入组的43例感染性休克患者根据复苏后P (cv-a) CO2/C(a-cv)O2结果，将患者分组即治疗组：ScvO2≥70%、P (cv-a) CO2/C(a-cv)O2<1.8；对照组组：ScvO2≥70%、P (cv-a) CO2/C(a-cv)O2≥1.8。采集所有入组患者入ICU液体复苏开始时（T0）和复苏6、24 h后（T6、T24）的以下数据：循环代谢指标：心率(HR)、平均动脉压(MAP)、心指数(CI)、中心静脉压（CVP），完善T0、T6、T24动脉及中心静脉血血气分析检查记录乳酸水平(Lac)、血氧饱和度(ScvO2)、动脉血二氧化碳分压(PaCO2)，并计算中心静脉-动脉二氧化碳分压差、动脉血氧含量、中心静脉血氧含量、氧输送（DO2）、氧耗（VO2）；记录患者T24、T48小时的急性生理与慢性健康评分（acute physiology and chronic health evaluationⅡ, APACHEⅡ）；住ICU时间及总住院时间、住院及28d死亡人数。结果 ①循环及氧代谢指标：2组患者治疗6 h、24 h后HR较治疗前下降，MAP、CI较治疗前明显升高；治疗24 h后治疗组患者HR较对照组下降更加显著，与对照组比较差异有统计学意义（P<0.05）；治疗组患者治疗6 h、24 h后CI升高更加显著，与对照组在同一时间比较差异有统计学意义（P<0.05）；治疗组患者在治疗24 h后Lac下降更加显著，与对照组比较差异有统计学意义（P<0.05）；治疗组患者在治疗24 h后DO2、VO2升高更加显著，与对照组比较差异有统计学意义（P<0.05）。②APACHEⅡ评分、住院时间及病死率：治疗后治疗组与对照组患者APACHEⅡ评分均下降，但治疗组下降更加明显，在治疗48 h后与对照组比较差异有统计学意义（P<0.05）；治疗组与对照组患者住ICU及总住院时间相比均缩短，2组比较差异均有统计学意义（P<0.05）；治疗组患者住院病死率及28 d病死率较对照组有下降，但差异无统计学意义（P＞0.05）。结论 P (cv-a) CO2 /C(a-cv)O2能反映感染性休克患者组织微循环灌注及组织细胞氧摄取情况，ScvO2≥70%、P (cv-a) CO2/C(a-cv)O2<1.8的患者组织氧供优于ScvO2≥70%、P (cv-a) CO2/C(a-cv)O2≥1.8的患者，患者组织细胞缺氧改善显著，患者ICU及总住院时间明显缩短，但患者病死率差异无统计学意义。

       

      Abstract: ob＜x＞jective To evaluate the clinical value of P (cv-a) CO2 /C(a-cv)O2 ratio in fluid resuscitation in patients with septic shock. Methods A total of 43 cases of patients with septic shock were enrolled in this study. They underwent the early liquid resuscitation treatment of 6 hours according to Surviving sepsis campaign 2012.After treatment of 6 hours, according to △PCO2/C(a-cv)O2 levels, which were divided into treatment group (<1.8, 31 cases) and control group(≥1.8, 12cases).The following data were colleted: HR, MAP, CI , lactic acid( Lac), DO2, VO2,APACHE Ⅱ score, duration of ICU and hospital stay, mortality in hospital and 28 day were also recorded. Results The HR of the two groups decreased after treatment., The MAP and CI were significantly higher than those before treatment, and the improvement of the treatment group was more obviously. After treatment of 24 hours, the HR of the treatment group was significantly lower than that of the control group (P<0.05); In the treatment group, the CI elevation was more significant after treatment of 6 h and 24 h (P<0.05). The decrease of Lac was more significant in the treatment group after treatment of 24 h(P<0.05), compared with the control group; The levels of DO2 and VO2 in the treatment group were significantly higher after r treatment of 24 hours (P<0.05)，compared with the control group。After treatment , the APACHE Ⅱ scores of the treatment group and the control group decreased, and Compared with the control group, the decline of the treatment group was more obviously after treatment of 48h(P<0.05)；The time of stay in ICU and hospital in treatment group were shorter than in control group（P<0.05).Conclusion P (cv-a) CO2 /C(a-cv)O2 can reflect tissue microcirculation perfusion and tissue oxygen uptake in patients with septic shock. Patients in the treatment group were better than those in the control group.The ICU and total hospital stay were significantly shorter, but the difference in mortality was not statistically significant.

       

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