ScvO_2、Pcv-aCO_2联合监测指导感染性休克患者液体复苏效果评估

Evaluation on Monitoring and Guiding Effect of ScvO_2 Combined with Pcv-aCO_2 on Fluid Resuscitation in Patients with Septic Shock

目的探讨分析中心静脉血氧饱和度联合中心静脉-动脉血二氧化碳分压差对感染性休克液体复苏的指导意义。方法选取58例感染性休克患者随机分为治疗组和对照组,均在常规治疗的基础上给予体液复苏,对照组患者复苏目标为Scv O_2(中心血氧饱和度)≥0.70,治疗组患者在对照组控制目标的基础上联合Pcv-a CO_2<6 mm Hg,比较两组患者临床效果、治疗前后观察指标,分析复苏6 h后Scv O_2≥0.70的患者Pcv-a CO_2与6 h乳酸清除率相关性。结果治疗组患者机械通气时间、ICU住院时间较对照组患者显著缩短,6 h平均补液量较对照组患者显著减少,28 d病死率较对照组患者显著降低,治疗后两组患者MAP、CVP、Scv O_2、乳酸清除率、CI、SCr指标水平均显著改善,且治疗组患者观察指标水平改善更显著,差异均具有统计学意义(P<0.05),复苏6 h后Scv O_2≥0.70的患者Pcv-a CO_2与6 h乳酸清除率呈现负相关(r=-0.754,P<0.001)。结论中心静脉血氧饱和度联合中心静脉-动脉血二氧化碳分压差应用于感染性休克患者体液复苏具有重要的指导意义,可有效评价患者的循环血流量,组织灌注状态及缺氧情况。

Objective To explore the monitoring and guiding effect of central venous oxygen saturation combined with central venous-arterial blood carbon dioxide partial pressure difference on fluid resuscitation in patients with septic shock. Methods 58 patients with septic shock were randomly selected and divided into treatment group and control group,both of whom were given fluid resuscitation on the basis of conventional therapy. The patients in the control group were treated with ScvO2（ central oxygen saturation） ≥0. 70. On the basis of the control group,the patients in the treatment group were treated with Pcv-a CO2〈6 mm Hg. The clinical effect of the two groups were compared,and the indexes were observed before and after treatment. The correlation between Pcv-a CO2 and lactate clearance at 6 h was analyzed in patients with Scv O2≥0. 70 after 6 hours’ fluid resuscitation. Results Compared with the control group,the treatment group boasted of significantly shorter duration of mechanical ventilation and stay length in ICU,remarkably lower average volume of fluid infusion within 6 hours,and notably lower mortality rate at 28 d. After treatment,the MAP,CVP,ScvO2,lactate clearance,CI and SCr of both groups were significantly improved,especially better in the treatment group,with statistically significant difference（ P 〈0. 05）. There was negative correlation between Pcv-a CO2 and lactate clearance at 6 h in patients with Scv O2≥0. 70 after 6 hours of fluid resuscitation（ r =-0. 754,P 〈0. 001）. Conclusion Central venous oxygen saturation combined with central venous-arterial blood carbon dioxide partial pressure difference is an important guideline for fluid resuscitation in patients with septic shock,which can effectively evaluate the circulatory blood flow,tissue perfusion and hypoxia in patients.