静动脉血二氧化碳分压差对感染性休克患者液体复苏的指导意义

The guiding significance of Pcv-aCO_2 for fluid resuscitation in patients with septic shock

目的探讨中心静脉与动脉血二氧化碳分压差(Pcv-aCO_2)对感染性休克患者液体复苏治疗的指导意义。方法选取2014年9月到2015年10月在重症医学科住院的感染性休克患者50例,所有患者进行液体复苏早期目标导向治疗(EGDT)6 h内达标,根据Pcv-aCO_2水平将患者分为Pcv-aCO_2≥6 mm Hg组和Pcv-aCO_2<6mm Hg组,比较两组在EGDT 0、12、24 h的血流动力学指标、循环灌注指标、器官功能评价指标、预后指标的差异。分析患者在EGDT达标0、12、24 h的Pcv-aCO_2与动脉血乳酸(Lac)清除率的相关性。结果两组患者在EGDT 12 h和24 h时的心率、Lac逐渐下降(P均<0.05),平均动脉压、中心静脉压、氧合指数、血清肌酐水平逐渐上升(P均<0.05),除Pcv-aCO_2≥6 mm Hg组的Lac高于Pcv-aCO_2<6 mm Hg组外(P均<0.05),其余指标两组均无显著差异(P均>0.05)。Pcv-aCO_2≥6 mm Hg者的Lac清除率和总液体入量低于Pcv-aCO_2<6 mm Hg者(P均<0.05)。两组患者在EGDT达标后各时间点的中心静脉血氧饱和度(Scv O2)均无明显变化(P均>0.05)。患者EGDT达标0、12、24 h的Pcv-aCO_2与Lac清除率均呈负相关(r=-0.398,-0.416,-0.410,P均<0.05)。结论感染性休克患者在EGDT达标后的Scv O2无明显变化,而Pcv-aCO_2可做为复苏效果的评价指标。

Objective To investigate the guiding significance of the central venous-to-acterial carbon dioxide difference （ Pcv-aCO2 ） for fluid resuscitation in patients with septic shock. Methods A total of 50 patients with septic shock, who received early goal directed therapy （EGDT） in ICU of Navy Anqing Hospital from September 2014 to October 2015 and reached the EGDT standards within 6 hours ,were selected and divided into Pcv-aCO2 ≥6 mm Hg group and Pcv-aCO2 〈6 mm Hg group based on the value of Pcv-aCO2. The differences of hemodynamic indicators, circulating perfusion indexes, or- gan function evaluation indexes ,prognostic indicators at 0 h, 12 h ,24 h after reaching the EGDT standard were compared between two groups, and the correlations between Pev-aCO： at 0 h, 12 h,24 h after reaching the EGDT standard and arterial blood lactate clearance rate were analyzed. Results Heart rate and arterial blood lactate level at 12 h and 24 h after reac- hing EGDT standard decreased gradually, and mean at-terial pressure （MAP） , central venous pressure （CVP） , oxygenation index （ PaOz/FiO： ）, serum ereatinine （SCr） gradually increased in both two groups （ all P 〈 0. 05 ）. There were no signifi- cant differences in aforementioned indicators between two groups except that the arterial blood lactate level of Pcv-aCO2 1〉 6 mm Hg group was higher than that of Pev-aCO2 〈 6 mm Hg group （ all P 〉 0. 05 ）. Arterial blood lactate clearance rate and total fluid intake volume in Pev-aCO2 ≥ 6 mm Hg group were statistically lower than those in Pcv-aCO2 〈 6 mm Hg group （ all P 〈 0. 05 ）. There were no statistically differenees in central venous blood oxygen saturation（ ScvO2 ） at each time points after reaching EGDT standards between two groups （ all P 〉 0. 05 ）. Pev-aCO2 at 0 h, 12 h,24 h after reaching EGDT standard were all negatively correlated with arterial blood lactate clearance rate （ r = - 0. 398, - 0. 416, - 0. 410, all P 〈 0. 05 ）. Conclusion ScvO2 after reaching EGDT standards basically remains unchanged in patients with septic shock, while Pev-aCO2 can be used as the evaluation index of resuscitation effect.