感染性休克患者PETCO_(2)监测与容量负荷试验结果的关系

Relationship between PETCO_(2) Monitoring and Volume Loading Test Results in Patients with Septic Shock

目的:探析感染性休克患者呼气末二氧化碳分压(PETCO_(2))监测与容量负荷试验(VE)结果的关系。方法:选择2018年8月-2020年12月本院重症医学科(ICU)住院诊治的感染性休克患者50例,均行机械通气治疗和VE。记录患者VE前后心率(HR)、中心静脉压(CVP)、每搏输出量(SV)、PETCO_(2)指标,对比有容量反应患者与无容量反应患者一般资料和血流动力学变化,分析PETCO_(2)变化与VE的相关性。结果:50例感染性休克患者中,35例有容量反应,15例无容量反应, VE后,有反应组SV、PETCO_(2)、MAP水平明显高于无反应组,CVP和HR明显低于无反应组(P<0.05), 有反应组△PETCO_(2)、△SV、△MAP、△HR高于无反应组,而△CVP明显低于无反应组(P<0.05), Pearson相关性分析显示感染性休克患者△PETCO_(2)与△SV呈正相关(r=0.586,P<0.05)。结论:感染性休克患者VE引起的PETCO_(2)变化可反映SV变化,能有效评估患者容量反应性,指导液体复苏治疗。

Objective:To investigate the relationship between partial pressure of end tidal carbon dioxide(PETCO_(2))monitoring and volume load test(VE)results in patients with septic shock.Method:Fifty patients with septic shock who were hospitalized in the department of intensive care unit(ICU)of our hospital from August 2018 to December 2020 were selected,all patients received mechanical ventilation treatment and VE.The heart rate(HR),central venous pressure(CVP),stroke volume(SV)and PETCO_(2)indexes were recorded before and after VE,the general data and hemodynamic changes were compared between patients with volume response and patients without volume response,and the correlation between PETCO_(2)change and VE was analyzed.Result:Of the 50 patients with septic shock,35 cases had volume response and 15 cases had no volume response.After VE,the levels of SV,PETCO_(2),MAP in the response group were significantly higher than those in the non-response group,and the CVP and HR levels were significantly lower than those in the non-response group(P<0.05);the levels of△SV,△PETCO_(2),△MAP and△HR in the response group were significantly higher than those in the non-response group,and the△CVP level was significantly lower than that in the non-response group(P<0.05).Pearson correlation analysis showed that△PETCO_(2)was positively correlated with△SV in septic shock patients(r=0.586,P<0.05).Conclusion:The change of PETCO_(2)induced by VE in patients with septic shock can reflect the change of SV,which can effectively evaluate the volume responsiveness of patients and guide fluid resuscitation treatment.