脓毒性休克患者中心静脉-动脉二氧化碳分压差的临床意义

Clinical significance of central venous-to-arterial carbon dioxide difference in patients with septic shock

目的探讨中心静脉血氧饱和度(ScvO2)≥70%的脓毒性休克患者中心静脉-动脉二氧化碳分压差[P(cv-a)CO2]与动脉血乳酸和序贯器官衰竭评分(SOFA)及预后的关系。方法入选时及治疗后24 h测定脓毒性休克患者的P(cv-a)CO2、动脉血乳酸、ScvO2及SOFA评分,并按入选时P(cv-a)CO2≥6.0 mmHg(A组)和P(cv-a)CO2<6.0 mmHg(B组)分成2组,比较2组的上述观察指标及住院28 d病死率。结果入选时2组间动脉血乳酸、ScvO2和SOFA评分差别无统计学意义;治疗24h,B组动脉血乳酸和SOFA评分明显下降(P<0.05),住院28 d病死率两组间差异无统计学意义(P>0.05)。结论 P(cv-a)CO2可作为脓毒性休克早期评价治疗效果的有效指标之一。

Objective To explore the relationship between central venous-to-arterial carbon dioxide difference[P（cv-a）CO2]and arterial lactate,SOFA score,as well as its outcome in patients with septic shock who had reached ScvO2≥70%.Methods P（cv-a）CO2,arterial lactate,and SOFA score were simultaneously measured at the time of admission and 24h after treatment in ICU.Patients were separated into two groups according to P（cv-a）CO2≥6.0mmHg（group A） and P（cv-a）CO26.0mmHg（group B）.The arterial lactate,SOFA score and 28-day mortality in hospital were compared between the two groups.Results There was no significant difference in arterial lactate,ScvO2 and SOFA score between the two groups at admission to ICU.24h after treatment,the difference of arterial lactate and SOFA score were significant between the two groups（P0.05）.Conclusion P（cv-a）CO2 may serve as a useful predictor to assess the effect of therapy in patients with septic shock.