乳酸、P(v-a)CO_2及P(v-a)CO_2/C(a-v)O_2在脓毒性休克早期液体复苏中的研究进展

Research Progress of Lactic Acid, P(v-a)CO_2 and P(v-a)CO_2/C(a-v)O_2 in the Early Fluid Recovery of Septic Shock

脓毒性休克治疗的关键是早期进行液体复苏,改善微循环,正确评价组织灌注情况。于是脓毒性休克早期液体复苏中的变化显得尤为重要,早期,经常使用中心静脉血氧饱和度(ScvO_2)、静-动脉二氧化碳分压差[P(v-a)CO_2]、乳酸来反应组织灌注情况,但逐渐发现其并不能完全反应液体复苏后患者组织缺氧状态,基于这种情况,一些新的指标被提出来,如静-动脉二氧化碳分压差/动-静脉氧气含量差P(v-a)CO_2/C(a-v)O_2,该文将针对脓毒性休克的微循环障碍及其评价指标的监测、有效性、临床应用优缺点作一综述。

The key of septic shock treatment is to recover the fluid in the early phase, improve the microcirculation and accurately evaluate the tissue perfusion, and the early fluid recovery changes of septic shock is especially important, in the early stage, we usually use the Scv O2,P（v-a）CO2 and lactic acid to reflect the tissue perfusion situation, but we gradually discover that it can＇t totally reflect the tissue anaerobic condition of patients after fluid recovery, based on the above, some new indicators are put forwards, such as P（v-a）CO2/C（a-v）O2, and the paper elaborates the microcirculation disorder and advantages and disadvantages of monitoring, effectiveness and clinical application of evaluation indicators.