静动脉血二氧化碳分压差联合下腔静脉呼吸变异度在脓毒性休克患者容量复苏中的价值

Value of Pcv-aCO_2 combined with inferior vena cava variability in volume resuscitation in patients with septic shock

目的探讨静动脉血二氧化碳分压差联合下腔静脉呼吸变异度在脓毒性休克患者容量复苏中的价值。方法选取收治的脓毒性休克患者作为研究对象,进行前瞻性观察性研究,在患者入重症监护病房(ICU)时,复苏6、12、24 h后测量患者心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)、乳酸(Lac)、下腔静脉呼吸变异度(VIVC)、静动脉血二氧化碳分压差(Pcv-aCO_2)水平;根据患者28 d病死率分为死亡组和存活组,比较2组患者复苏24 h乳酸清除率、VIVC、Pcv-aCO_2、急性生理和病理评分(APACHEⅡ评分)、感染相关器官功能衰竭评分(SOFA评分)等指标。通过ROC曲线分析Pcv-aCO_2联合VIVC的应用价值。结果复苏6、12、24 h时患者MAP、VIVC、Lac及Pcv-aCO_2水平均较复苏前明显改善,且差异有统计学意义(P <0. 05);死亡组患者复苏24 h的APACHEⅡ评分、SOFA评分、VIVC及Pcv-aCO_2水平显著高于存活组(P <0. 05),且死亡组患者乳酸清除率显著低于存活组(P <0. 05);高Pcv-aCO_2组患者APACHEⅡ评分、SOFA评分、VIVC及死亡率均显著高于低PcvaCO_2组(P <0. 05),乳酸清除率显著低于低Pcv-aCO_2组(P <0. 05);高VIVC组患者APACHEⅡ评分、SOFA评分、Pcv-aCO_2及死亡率均显著高于低VIVC组(P <0. 05),乳酸清除率显著低于低VIVC组(P <0. 05)。结论在脓毒性休克患者容量复苏过程中采用Pcv-aCO_2联合VIVC检测可有效提高患者预后质量,具有较高的临床应用价值。

Objective To investigate the value of Pcv-aCO_2 combined with VIVC in patients with septic shock.Methods The patients with septic shock were selected as the object of study in this group,heart rate,CVP and MAP,lactic acid,APACHE Ⅱ,VIVC and Pcv-aCO_2 levels were measured in patients before and 6 h after recovery. Results The recovery rate of MAP,VIV,lactic acid and Pcv-aCO_2 and SOFA in patients with 6 h,12 h and 24 h after resuscitation were significantly better than those before resuscitation,and the difference was statistically significant 6 h after resuscitation in patients with MAP,VIVC,lactic acid and Pcv-aCO_2 level were significantly improved after recovery（P 0. 05）; Death group of patients with APACHE score,VIVC score and Pcv-aCO_2 score were significantly higher than the survival group and death group（P 0. 05）,lactate clearance rate and SOFA score were significantly lower than that of patients with high survival group（P 0. 05）; Pcv-aCO_2 group of patients with APACHE score,VIVC and mortality were significantly higher than that in low Pcv-aCO_2 group（P 0. 05）,Pcv-aCO_2 group of patients with high lactate clearance rate and SOFA score were was significantly lower than that in low Pcv-aCO_2 group（P 0. 05）; Group VIVC patients with high APACHE score,Pcv-aCO_2 and mortality were significantly higher than the low VIVC group（P 0. 05）,high VIVC group of lactic acid the clearance rate and SOFA score were significantly lower than that in low VIVC group（P 0. 05）. Conclusion Pcv-aCO_2 combined with VIVC can improve the prognosis of patients with septic shock,and it has a high clinical value.