脓毒性休克氧代谢的监测和临床应用

Monitoring Oxygen Metabolism and Its Application in Septic Shock

【摘要】脓毒性休克的复苏目标是恢复患者的生理状态，改善终末器官灌注，满足组织代谢需求。理想的复苏终点目标是适当的组织氧输送和氧消耗，这一目标可定量评估。尽管经多年研究，但尚未发现任何单一复苏终点目标能够单独用来评估复苏的适当性。因此临床医生必须使用多个复苏终点目标综合评估患者对治疗的反应。本文将讨论氧代谢参数包括氧输送（DO2）、氧消耗（VO2）、乳酸（Lac）、乳酸清除率（LC）、混合静脉血或中心静脉氧饱和度（SvO2 or ScvO2）、混合静脉血或中心静脉血—动脉血二氧化碳分压差[P（v-a）CO2或P（ev—a）CO2]作为复苏终点目标在脓毒性休克中的作用和局限性，并讨论如何应用这些参数指导脓毒性休克的临床治疗。

Resuscitation goals for the patient with septic shock are to return the patient to a physiologic state that promotes adequate end-organ perfusion along with matching metabolic supply and demand. Ideal re- suscitation end points should assess the adequacy of tissue oxygen delivery and oxygen consumption, and be quantifiable. Despite years of research, a single resuscitation end point to assess adequacy of resuscitation has yet to be found. Thus, the clinician must rely on multiple end points to assess the patient＇s overall re- sponse to therapy. This review will discuss the role and limitations of oxygen metabolism parameters, such as oxygen delivery （ DO2 ）, oxygen consumption （ VO2 ）, lactate （ Lac）, lactate clearance （ LC ）, mixed or central venous oxygen saturation （ SvO2 or SevO2 ） , mixed or central venous-arterial CO2 difference [ P （ v- a） CO2 or P （cv-a） CO2 ] as microcirculatory resuscitation endpoints in patients with septic shock and how to use these parameters to guide the therapy for septic shock.