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    中心静脉-动脉CO2分压差/动脉-中心静脉氧含量差比值在感染性休克患者复苏中的应用

    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CO2分压差〔P (cv-a) CO2〕/动脉-中心静脉氧含量差〔C(a-cv)O2〕比值监测在感染性休克患者复苏中的价值。方法 根据复苏治疗6 h后P (cv-a) CO2/C(a-cv)O2比值监测结果将43例感染性休克患者分为2组。治疗组(n=31):P (cv-a) CO2/C(a-cv)O2比值<1.8,中心静脉血氧饱和度(ScvO2)≥70%;对照组(n=12):P (cv-a) CO2/C(a-cv)O2比值≥1.8,ScvO2≥70%。观察2组患者复苏治疗开始时(T0)和复苏6 h(T6)、24 h(T24)时的心率(HR)、平均动脉压(MAP)、心指数(CI)、中心静脉压(CVP),以及动脉血及中心静脉血血气分析结果,记录乳酸、ScvO2、动脉血CO2分压(PaCO2),并计算P (cv-a) CO2、动脉血氧含量、中心静脉血氧含量、氧输送(DO2)、氧耗(VO2),并记录患者复苏治疗时的急性生理与慢性健康评分(APACHE Ⅱ)、入住ICU及总住院时间、住院病死率及28 d病死率。结果 ①循环及氧代谢指标:在T24时治疗组HR、乳酸下降,DO2、VO2升高较对照组更加显著(P<0.05);在T6、T24时治疗组较对照组CI升高更加显著(P<0.05);②APACHE Ⅱ评分、住院时间及病死率: 治疗后治疗组与对照组APACHE Ⅱ评分均下降,在T24治疗组下降更加明显(P<0.05);治疗组入住ICU及总住院时间均较对照组缩短(P<0.05);治疗组与对照组患者住院病死率及28 d病死率差异均无统计学意义(P＞0.05)。结论 P(cv-a) CO2/C(a-cv)O2比值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,与P(cv-a)CO2/C(a-cv)O2比值≥1.8的患者相比P(cv-a)CO2/C(a-cv)O2比值<1.8的患者组织氧供改善显著,入住ICU及总住院时间明显缩短,但两者的病死率差异无统计学意义。

       

      Abstract: Objective To evaluate the clinical value of P (cv-a) CO2/C(a-cv)O2ratio in fluid resuscitation in patients with septic shock. Methods According to the monitoring results of P(cv-a)CO2/C(A-CV)O2 ratio after resuscitation treatment for 6 h, 43 patients with septic shock were divided into two groups. Treatment group(n=31): P(cv-a)CO2/C(A-CV)O2 ratio<1.8, central venous oxygen saturation(ScvO2)≥70%. Control group(n=12): P(cv-a)CO2/C(A-CV)O2 ratio≥1.8, ScvO2≥70%. The following data were collected: heart rate(HR), mean arterial pressure(MAP), cardiac index(CI), central venous pressure(CVP) at the beginning of resuscitation(T0), 6 h(T6)and 24 h(T24)after resuscitation, and the blood gas analysis results of arterial blood and central venous blood were also recorded. Lactate acid, ScvO2and PaCO2were recorded, and P(cv-a)CO2 was calculated. Arterial oxygen content, central venous blood oxygen content, oxygen delivery(DO2) and oxygen consumption(VO2) were also calculated. The Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) scores, length of ICU stay and total hospital stay, in-hospital mortality and 28-d mortality were recorded. Results At T24, HR and lactate acid level decreased in the treatment group, and DO2and VO2increased more significantly than the control group(P<0.05). At T6 and T24, CI increased more significantly in the treatment group than that in the control group(P<0.05). After treatment, the APACHE II scores decreased in both groups, and the decrease in the treatment group was more obvious at T24, and the difference was statistically significant compared with the control group(P<0.05). Compared with the control group, the length of ICU stay and total hospital stay of the treatment group were shortened(P<0.05). There was no significant difference between the two groups in hospital mortality and 28-d mortality(P>0.05). Conclusions P(cv-a)CO2/C(a-cv)O2 can reflect tissue microcirculation perfusion and tissue cell oxygen uptake in patients with septic shock. The tissue oxygen supply in patients with P(cv-a)CO2/C(a-cv)O2≥1.8 is better than that in patients with P(cv-a)CO2/C(a-cv)O2 <1.8, with significantly shortened length of ICU stay and total hospital stay, but the mortality between the two groups is not statistically significant.

       

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