pH值对脓毒症休克复苏的影响

Effect of pH value on the resuscitation of patients with septic shock

目的观察不同pH值对脓毒症休克复苏的早期复苏、持续复苏、生存率的影响。方法收集早期脓毒症休克患者73例,根据复苏前血气分析分3组:pH≤7.15 21例为A组;7.15<pH<7.25 27例为B组,pH≥7.25 25例为C组,行复苏治疗。比较3组复苏治疗前血乳酸值,6 h复苏达标率、血乳酸清除率,24 h、48 h中心静脉氧饱和度(ScVO2)达标率、血乳酸正常率,28 d生存率。结果 3组复苏治疗前血乳酸值比较差异无统计学意义(P均>0.05);3组6 h复苏达标率比较差异有统计学意义(P均<0.05),MVP、ScVO2、血乳酸清除率比较差异无统计学意义(P均>0.05);3组24 h ScVO2比较差异无统计学意义,血乳酸正常率A组与C组比较差异有统计学意义(P均<0.01),48 h ScVO2、血乳酸正常率A组与C组比较差异有统计学意义(P均<0.05);28 d生存率A组为29%,B组为44%,C组为68%,C组生存率明显高于A组(P<0.05)。结论不同pH值脓毒症休克复苏前血乳酸值无差异;早期复苏可以改善不同pH值的休克患者低灌注与氧代谢,pH值低的休克患者液体复苏难以持续改善低灌注与氧代谢。

Objective It is to observe different value of pH on early resuscitation , sustained resuscitation and survival rate in patients with septic shock .Metho ds 73 patients with septic shock were selected and divided into 3 groups according to their blood gas analysis before resuscitation：group A（pH〈7 .15, n=21）, group B （7.15〈pH〈7.25, n=27）, group C（pH〉7.25, n=25）, all the groups were given resuscitation therapy .Blood lactic acid level,target rate of resuscitation and clearing rate of blood lactic acide after 6h, target rate of ScVO2 after 24 h and 48 h, normal rate of blood lactic acid and 28 d survival rate among the three groups were compared .Results At baseline before resuscitation , there was no significant difference in blood lactate among three groups （ P〉0 .05;At 6 hours after resuscitation ,there was significant difference in target rate of re-suscitation（P〈0.05）, while no difference in MVP, ScVO2 and lactic acid clearing rate among the three groups （P〉0.05）. At 24 h after resuscitation , no significant difference in ScVO 2 was found among the three groups , but normal rate of lactic acid had significant difference between group A and group C （P〈0.01）.At 48 h ScVO2 and normal rate of lactic acid had signifi-cant differences between group A and group C （P〈0.05）.The survival rate at 28 d in group A was 29%, in group B was 44%and 68%in group C, the rate was obviously higher in group C than that in group A （P〈0.05）.Conclusion Before re-suscitation ,there is no significant difference in blood lactate in septic shock patients with different pH value , early resuscitation can improve lower perfusion and oxygen metabolism , but further fluid resuscitation is difficult to continuously improve low per-fusion and oxygen metabolism in patients with lower pH value .