中心静脉血氧饱和度联合静动脉二氧化碳分压差在产后出血液体复苏治疗中的指导作用

Guiding effect of central venous oxygen saturation combined with static arterial central venous-to-arterial carbon dioxide difference on fluid resuscitation treatment of postpartum hemorrhage

目的探讨中心静脉血氧饱和度(ScvO_(2))联合静动脉二氧化碳分压差[P(v-a)CO_(2)]在产后出血(PPH)液体复苏治疗中的指导作用。方法选取2022年2月至2023年3月江西省妇幼保健院收治的60例胎盘植入、前置胎盘剖宫产术中大出血患者作为研究对象,按照随机数字表法分成试验组(n=30)和对照组(n=30)。对照组行常规液体复苏干预,试验组行ScvO_(2)联合P(v-a)CO_(2)监测指标进行复苏干预。比较两组患者容量达标时间、液体复苏前后氧合指数、6 h乳酸清除率、24 h乳酸清除率及并发症发生率。结果试验组的容量达标时间短于对照组,差异有统计学意义(P<0.05);液体复苏6、24 h后试验组的氧合指数均高于对照组,差异有统计学意义(P<0.05);试验组6h乳酸清除率、24h乳酸清除率均高于对照组,差异有统计学意义(P<0.05);试验组的并发症总发生率(16.67%)低于对照组(40.00%),差异有统计学意义(P<0.05)。结论ScvO_(2)联合P(v-a)CO_(2)监测对PPH患者液体复苏治疗具有指导作用,能缩短液体复苏时间,提高氧合指数和乳酸清除率,降低并发症的发生。

Objective To investigate the guiding role of central venous oxygen saturation(ScvO_(2))combined with the central venous-to-arterial carbon dioxide difference(P[v-a]CO_(2))in fluid resuscitation treatment of postpartum hemorrhage(PPH).Methods Sixty patients with massive hemorrhage during cesarean section of placenta implantation and placenta previa ad-mitted to Jiangxi Maternal and Child Health Hospital from February 2022 to March 2023 were selected as the study objects,and divided into experimental group(n=30)and control group(n=30)according to random number table method.The control group received conventional liquid resuscitation intervention,and the experimental group received ScvO_(2) combined with P(v-a)CO_(2) monitoring index for resuscitation intervention.The volume reaching time,oxygenation index before and after flu-id resuscitation,6 h lactic acid clearance rate,24 h lactic acid clearance rate and complication rate of the two groups were compared.Results The volume reaching time of experimental group was shorter than that of control group,and the difference was statistically significant(P<0.05).After fluid resuscitation for 6 and 24 h,the oxygenation index of the experimental group was higher than that of the control group,and the differences were statistically significant(P<0.05).The 6 h lactic acid clearance rate and 24 h lactic acid clearance rate of experimental group were higher than those of control group,and the differences were statistically significant(P<0.05).The total complication rate of experimental group(16.67%)was lower than that of control group(40.00%),and the difference was statistically significant(P<0.05).Conclusion Monitoring ScvO_(2) and P(v-a)CO_(2) can guide fluid resuscitation of PPH.Fluid resuscitation under the monitoring of ScvO2 and P(v-a)CO2 can shorten the duration of fluid resuscitation,improve oxygenation index and lactate clearance rate,and reduce the incidence of complications.