感染性休克复苏的临床评估

Clinical assessment of resuscitation in septic shock

微循环障碍是感染性休克的中心环节,复苏的目标是恢复组织灌注和细胞氧代谢平衡。传统的临床指标血压、心率、尿量、皮温等难以评价组织灌注和细胞氧代谢复苏效果,最佳复苏评估指标需要包括血流动力学、组织灌注及细胞氧代谢相关指标。早期目标化治疗所包含的综合性指标平均动脉压(MAP)≥65mmHg(1mmHg=0.133kPa),中心静脉压(CVP)8～12mmHg,尿量>0.5mL(/kg·h),中心静脉血氧饱和度(ScvO2)>65%或混合静脉血氧饱和度(SvO2)>70%,可以作为临床常规评估的重要依据。

The central role of septic shock is microcirculation disturbance. Major resuscitation goals for septic shock include restoration of adequate tissue perfusion and oxygen balance and normalization of cellular metabolism. Traditional endpoints of resuscitation, such as HR, BP, urine output, and skin perfusion are inadequate to evaluate the effect of resuscitation. Optimal resuscitation endpoints need to include hemodynamics status, tissue perfusiou and oxygenation. The parameters in early goal-directed therapy including mean arterial pressure ≥65mmHg, central venous pressure 8- 12mmHg, urine output 〉 0.5mL/kg.h, ScvO2 〉 65% or SvO2 〉 70% become the popular parameters in clinical assessment.