中心静脉血氧饱和度及动脉血乳酸对严重感染病人液体复苏指导作用的研究

Directive value of lactate clearance and central venous oxygen saturation in the patients with severe sepsis or septic shock

目的研究应用中心静脉血氧饱和度(ScvO2)和血乳酸清除率指导严重感染病人液体复苏的意义。方法将2006年1月至2006年12月中国医科大学附属第一医院重症医学科收治的74例严重感染及感染性休克病人随机分组,分别以容量复苏成功(A组),容量复苏成功且ScvO2>70%(B组),容量复苏成功且乳酸清除率达10%(C组)为目标。确诊后经验性给予抗生素治疗的同时积极进行液体复苏达标后维持72h。结果B组和C组发生多器官功能障碍综合征(MODS)的比例分别为33.3%和28.6%,均低于A组(54.5%),其中C组与A组比较有统计学意义(P=0.043)。A组和B组7d病死率(27.3%,20.8%)接近且均高于C组(3.6%),A组与C组比较有统计学意义(P=0.021)。从生存分析曲线来看B、C两组病死率均低于A组。B组和C组病人住ICU时间分别为(6.53±12.10)d和(6.95±13.52)d均短于A组(8.465±11.97)d,P<0.05。结论应用ScvO2及血乳酸清除率指导严重感染的液体复苏可以降低严重感染和感染性休克病人MODS的发生率及病死率。

Objective To evaluate the efficacy of the lactate clearance and central venous oxygen saturation （ScvO2） directed therapy in severe sepsis and septic shock. Methods According to the goal of therapy, 74 patients with severe sepsis or septic shock admitted between January 2006 and December 2006 at the Department of ICU, the First Hospital of China Medical University were assigned into three groups： A group （fluid resuscitation for 72 hours）; B group（fluid resuscitation and SevO2 ≥ 70% for 72 hours）; C group （fluid resuscitation and lactate clearance ≥ 10% for 72 hours）. Results The rates of MODS in B group and C group were lower than that in C group （33.3% vs 54.5%; 28.6% vs 54.5 %, P 〈 0.05）. Mortality rate at 7 day in C group was lower than that in A group （P 〈 0.05）. Mortality rates in B group and C group were lower than that in A group. Time of stay in ICU in B group and C group were shorter than that in A group （P 〈 0.05）. Conclusion Therapy directed by lactate clearance and ScvO： is associated with decreased mortality rate and rate of MODS in patients with severe sepsis or septic shock.