静动脉二氧化碳分压差对脓毒性休克患者容量反应性的预测价值

The value of central venous-to-arterial carbon dioxide partial pressure difference in predicting capacity reactivity in patients with septic shock

目的 探讨静动脉二氧化碳分压差(Pcv-aCO2)对脓毒性休克患者容量反应性的预测价值。方法 回顾性分析2014年1月至2017年12月该院收治的89例脓毒性休克患者临床资料,分析复苏前、复苏后6hPcv-aCO2、心输出量(CO)、心指数(CI)、血乳酸的变化;根据复苏后6h的Pcv-aCO2,将所有患者分为Pcv-aCO2≥6.0mm Hg组(A组,48例)和Pcv-aCO2<6.0mm Hg组(B组,41例),比较两组心率(HR)、CO、CI、乳酸清除率、病死率等指标;治疗28d后观察患者存活情况,将其分为生存组和病死组,比较两组复苏后6h的急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、Pcv-aCO2、乳酸清除率;分析复苏前、复苏后6hPcv-aCO2与动脉血乳酸、CO、CI的相关性。结果 复苏后6h,所有患者CO、CI升高,乳酸、Pcv-aCO2降低(P<0.05)。复苏前后HR无明显差异(P>0.05)。复苏后6h,A组病死率高于B组,CO、CI及乳酸清除率均低于B组(P<0.05);治疗28d后,生存组APACHEⅡ评分、Pcv-aCO2低于病死组,乳酸清除率高于病死组(P<0.05);复苏前,Pcv-aCO2与乳酸清除率、CO、CI无明显相关性(P>0.05);复苏后6h,Pcv-a CO2与CO、CI及乳酸清除率呈明显正相关(r=0.714、0.625、0.683,均P=0.001)。结论 较高水平的Pcv-aCO2可能预示患者预后不良,Pcv-aCO2可成为脓毒性休克患者的疗效评价指标之一。

Objective To explore the predictive value of central venous-to-arterial carbon dioxide partial pressure difference(Pcv-aCO 2)in capacity reactivity in patients with septic shock.Methods The clinical data of 89 patients with septic shock admitted to this hospital from January 2014 to December 2017 were retrospectively analyzed.The changes of Pcv-aCO 2,cardiac output(CO),cardiac index(CI)and blood lactic acid before and 6 h after resuscitation were analyzed.According to the value of PCv-aCO 2 at 6 h after resuscitation,all patients were divided into the Pcv-aCO 2≥6.0 mm Hg group(group A,48 cases)and the Pcv-aCO 2<6.0 mm Hg group(group B,41 cases),and the heart rate(HR),CO,CI,lactate clearance rate and mortality were compared between the two groups.Survival situation was observed 28 d after treatment,and all patients were divided into the survival group and the death group.The acute physiological function and chronic health score systemⅡ(APACHEⅡ)score,Pcv-aCO 2 and lactate clearance rate were compared between the two groups 6 h after resuscitation.The correlation of Pcv-aCO 2 with lactate,CO and CI in arterial blood before and 6 h after resuscitation was analyzed.Results At 6 h after resuscitation,CO and CI increased,lactic acid and Pcv-aCO 2 decreased in all patients(P<0.05),and no statistically significant difference was observed in HR between before and after resuscitation(P>0.05).At 6 h after resuscitation,in group A the mortality was higher than that in group B,and the CO,CI and clearance rate of lactic acid were lower than those in group B(P<0.05).After 28 d of treatment,the APACHEⅡscore and Pcv-aCO 2 in the survival group were lower than those in the death group,and the clearance rate of lactic acid in the survival group was higher than that in the death group(P<0.05).Before resuscitation,there was no significant correlation between Pcv-aCO 2 and clearance rate of lactic acid,CO and CI(P>0.05).At 6 h after resuscitation,the Pcv-aCO 2 was positively correlated with CO,CI and clearance rate of lactate(r=0.714,0.625,0.683,P=0.001).Conclusion The Pcv-aCO 2 in higher level may predict poor prognosis,and Pcv-aCO 2 could be used as one of the effective indicator for patients with septic shock.