脓毒性休克患儿血液氧代谢指标变化及其临床意义

Changes in blood oxygen metabolism indices and their clinical significance in children with septic shock

脓毒性休克治疗的关键是提供充足的氧供和改善组织灌注,目前常用的反映氧代谢的指标是乳酸(Lac)和中心静脉血氧饱和度(ScvO_2),但是当乳酸和ScvO_2处于正常范围时,组织仍然可能存在缺氧。静动脉二氧化碳分压差(CO_2 gap)在ScvO_2正常时可以准确反映机体氧供情况。本文就乳酸和乳酸清除率、ScvO_2和CO_2 gap在判断组织缺氧时的优点和不足进行综述,以期为脓毒性休克的治疗和病情判断提供依据。

The key to the treatment of septic shock is to provide adequate oxygen supply and improve tissue perfusion. Lactate and central venous oxygen saturation（ScvO_2） are commonly used as the indices of oxygen metabolism, but tissue hypoxia may still exist even when lactate and ScvO_2 are within the normal range. Arteriovenous difference in carbon dioxide partial pressure（CO_2 gap） can accurately reflect oxygen delivery when ScvO_2 is in the normal range. This article reviews the advantages and shortages of lactate, lactate clearance rate, ScvO_2, and CO_2 gap in evaluating tissue hypoxia, in order to provide a reference for treatment and severity evaluation of septic shock.