动静脉二氧化碳分压差联合钠尿肽测定在脓毒性休克患者液体复苏中的作用

The Role of Arteriovenous Carbon Dioxide Partial Pressure Difference Combined with Natriuretic Peptide Determination in Fluid Resuscitation in Patients with Septic Shock

目的探究动静脉二氧化碳分压差(Pcv-aCO2)联合氨基末端利钠肽前体(NT-proBNP)测定在脓毒性休克患者液体复苏中的作用。方法方便选取2015年3月—2016年2月该院收治的72例脓毒性休克患者为研究对象。对比复苏前后观测指标;根据患者治疗28 d后是否存活将患者分为存活组、死亡组,对比复苏6 h时两组观察指标;根据复苏6 h时NT-proBNP是否≥500 pg/mL分为高NT-proBNP组和低NT-proBNP组,对比两组相关指标。结果相比液体复苏前,复苏6 h时72例患者MAP、ScvO2增高(P<0.05);CVP增高但不显著(P>0.05);乳酸、Pcv-aCO2、NT-proBNP降低(P<0.05),复苏前MAP(52.14±3.17)mmHg,CVP(8.47±2.74)mmHg,复苏6 hMAP(85.24±6.89)mmHg,CVP(8.62±3.96)mmHg(t=37.032,P=0.000、t=0.264,P=0.792)。72例患者在治疗28 d后存活44例,死亡28例;死亡组Pcv-aCO2、NT-proBNP以及APACHE II评分均高于存活组(P<0.05);高NT-proBNP组、Pcv-aCO2显著高于低NT-proBNP组(P<0.05),死亡组Pcv-aCO2(8.57±2.19)mmHg,存活组为Pcv-aCO2(3.28±1.81)mmHg,死亡组的APACHE II(29.87±4.07)分,存活组为(15.28±2.34)分。APACHEII评分对比差异无统计学意义(t=1.646,P=0.104);乳酸清除率高NT-proBNP组低于低NT-proBNP组(t=5.543,P=0.000)。结论NT-proBNP可作为脓毒性休克患者预后评估的重要指标,Pcv-aCO2联合NT-proBNP测定在脓毒性休克患者液体复苏中颇具指导作用。

Objective To explore the difference of arteriovenous co2 partial pressure(Pcv-aCO2)in combination with amino terminal natriuretic peptide precursor(NT-proBNP)to determine the role of liquid recovery in patients with septic shock.Methods Selected in March 2015 to February 2016 convenient selection in our hospital treated 72 cases of patients with septic shock as the research object.Contrast observation indexes before and after recovery;According to the treatment of 28 days whether live divided the patients into survival group and death group,compare the recovery of 6h two groups of observation indexes;According to whether NT-proBNP acuity recovery 6 h 500 pg/mL divided into high NT-proBNP and low NT-proBNP group,compared two groups of related indicators.Results Compared with fluid resuscitation,MAP and ScvO2 increased in 72 patients at 6h after resuscitation(P<0.05);CVP increased but not significant(P>0.05);lactate,Pcv-aCO2,NT-proBNP decreased(P<0.05)before resuscitation MAP(52.14±3.17)mmHg,CVP(8.47±2.74)mmHg,recovery 6 hMAP(85.24±6.8*9)mmHg,CVP(8.62±3.96)mmHg(t=37.032,P=0.000,t=0.264,P=0.792).Of the 72 patients,44 survived 28 days after treatment and 28 died;the Pcv-aCO2,NT-proBNP and APACHE II scores in the death group were higher than those in the survival group(P<0.05);high NT-proBNP The group,Pcv-aCO2 was significantly higher than the low NT-proBNP group(P<0.05),the death group was Pcv-aCO2(8.57±2.19)mmHg,the survival group was Pcv-aCO2(3.28±1.81)mmHg,and the death group was APACHE II(29.87±4.07)points,the survival group was(15.28±2.34)points;APACHEII scores were not significantly different(t=1.646,P=0.104);high lactate clearance rate was lower in NT-proBNP group than in low NT-proBNP group(t=5.543,P=0.000).Conclusion The NT-proBNP can be used as important indicators of evaluation of the prognosis of patients with septic shock,Pcv-aCO2 joint determination of NT-proBNP in patients with septic shock liquid is guiding role in the recovery.