失血性低血容量休克氧动力学和血乳酸的临床评估作用

Hemorrhagic hypovolemic shock:calinical evaluation of oxygen dynamics and blood lactate level.

目的 评估创伤后失血性休克重症病人的复苏指标。方法 前瞻法临床研究 1995年 1月至 1999年1月期间 ,进入外科重症加强医疗病区 (SICU)的连续 41例创伤后失血性低血容量休克病人。对所有病例常规采用止血、扩充血容量、儿茶酚胺类药物、稳定内环境等复苏措施 ,测定初始、12、2 4、48、72h血流动力学、氧动力学、血乳酸变化以及 2 4h内APACHEⅡ评分 ,比较存活组与死亡组资料。结果 (1)存活组 34例 (83 % ) ,死亡组 7例(17% ) ,均死于多器官功能衰竭 (MOF)。 (2 )从第二个 2 4小时开始 ,存活组CI、DO2 I、VO2 I平均水平显著高于死亡组。 (3)两组病人第一个 12小时的血乳酸均高于正常水平 ,死亡组显著高于存活组。存活组第一个 12小时开始降低 ,2 4小时至正常水平 ,与死亡组比较有显著差异 (P <0 0 1)。死亡组至 72小时仍显著保持高于正常血乳酸水平。 (4 )SvO2 在 2 4小时两组显示出显著差异 ,存活组显著高于死亡组 (P <0 0 5 )。 (5 )存活组MAP、CVP、PAWP的变化与死亡组比较无显著差异。 (6 )第一个 2 4小时的APACHEⅡ两组比较无显著差异。结论 血乳酸、SvO2 与DO2 I可作为失血性休克的重症病人早期评估复苏效果的良好指标 ,动态监测有较大意义。

Objective To evaluate the resuscitation indications of patients with hemorrhagic hypovolemic shock after trauma.Methods We studied prospectively 41 postoperative hemorrhagic hypovolemic shock patients who was admitted consecutively to 8 beds in surgical intensive care unit of our hospital between January 1995 and January 1999.All patients were given routine resuscitation treatment,including hemostasia,volume expansion,inotropic agents and internal circumstance stabilization.The data of hemodynamics and oxygen dynamics and artery lactate levels were measured at the beginning and 12,24,48 and 72 hours and acute physiologic and chronic healthy evaluation Ⅱ (APACHE Ⅱ) was made within 24 hours.Patients were analyzed with respect to survival versus nonsurvival.Results (1)34 patients of 41(83%) survived.Seven died of multiple organ failure.(2)From the beginning of the second 24 hours,CI,DO 2I,VO 2I of survivors are higher than those of nonsurvivors.(3)In the first 12 hours,survivors' blood lactate started to fall to normal level on 24 hours,and was statistically significant lower than nonsurvivors' on 48 and 72 hours (P< 0 01).(4)There was statistically significant difference of SvO 2 between the two groups on 24 hours,SvO 2 of survivors are significantly higher than those of nonsurvivors(P<0 05).(5)There was no statistically significant difference between the two groups with respect to MAP,CVP,PAWP and APACHEⅡ on 24 hours.Conclusion To evaluate the resuscitation of hemorrhagic hypovolemic shock after trauma,blood lactate,SvO 2 and DO 2I are excellent indicators.