中心静脉压联合全心舒张末容积指数指导感染性休克患者容量治疗的效果

Effectiveness of volume therapy guided by response of CVP and global end-diastolic volume index in septic shock patients

目的评价中心静脉压（CVP）联合全心舒张末容积指数（GEDVI）指导感染性休克患者容量治疗的效果。方法感染性休克患者23例，性别不限，年龄18～64岁，休克时间〈6h，急性生理和慢性健康状况评分13～31分，采用随机数字表法，将其随机分为2组：CVP指导容量治疗组（Ⅰ组，n=12）和cvp联合GEDVI指导容量治疗组（Ⅱ组，n=11）。2组均静脉输注生理盐水和6％羟乙基淀粉200／0．5，晶体液和胶体液的比例为1：（0．5～1．0），输注速率800～1600ml／h，容量治疗过程中Ⅰ组维持CVP8—12mmHg；Ⅱ组维持CVP〉8mmHg和GEDVI600～750ml／m2。分别于容量治疗前及容量治疗开始后6h时采集动脉及中心静脉的血样，测定血乳酸浓度和中心静脉血氧饱和度（Scv02），计算乳酸和ScvO2的变化率。结果与Ⅰ组比较，Ⅱ组乳酸变化率升高（P〈0．05），ScvO2变化率差异无统计学意义（P〉0．05）。结论与CVP指导容量治疗比较，CVP联合GEDVI指导感染性休克患者容量治疗时可增加组织灌注，其效果较好。

Objective To evaluate the effectiveness of volume therapy guided by the response of CVP and global end-diastolic volume index （GEDVI） in septic shock patients. Methods Twenty-three patients of both sexes aged 18-64 yr who had been in septic shock for 〈 6 h were randomly divided into 2 groups： control group （groupⅠI , n = 12） and study group （group Ⅱ , n = 11 ）. Tracheal intubation was performed and the patients were me- chanically ventilated in both groups. Right internal jugular vein or subclavian vein was cannulated for CVP monitoring and fluid administration. PiCCO catheter was inserted into femoral artery. Normal saline, 6 % hydroxyethyl starch 200/0.5, albumin and plasma were infused via CVP line. CVP was maintained ≥ 8 mm Hg in both groups while in 11 group GEDVI was maintained at 600-750 ml/m2 during resuscitation. Blood samples were taken from artery and CVP line before （baseline） and at 6 h of volume therapy （T2 ） for determination of blood lactate concentration and central venous oxygen saturation （ ScVO2 ）. The changing rate of lactate （ （ baseline lactate concentration-lactate concentration at 6 h of volume therapy） ＋ baseline value × 100% ） and ScvO2 （ （ScvO2 at 6 h of volume therapy - baseline ScvO2 ） ＋ baseline value × 100 % ） ） was calculated. Results The changing rate of lactate was significantly higher in Ⅱ group than in Ⅰ group. There was no significant difference in the changing rate of ScvO2 between the 2 groups. Conclusion Volume therapy guided by CVP and GEDVI can provide better tissue perfusion than by CVP alone in septic shock patients.