静脉-动脉血二氧化碳分压差和静脉血氧饱和度监测在感染性休克中的临床价值

Clinical value of venous-arterial carbon dioxide partial pressure difference combined with venous oxygen saturation monitoring in patients with septic shock

目的探讨静脉-动脉血二氧化碳分压差[P(cv-a)CO2]和静脉血氧饱和度(ScvO2)监测在感染性休克中的临床价值。方法选取2018年10月至2020年10月景德镇第二人民医院收治的86例感染性休克患者作为研究对象,采用随机数字表法分为对照组(43例)和治疗组(43例)。对照组以患者ScvO2水平为指导目标进行液体复苏,治疗组以患者ScvO2水平联合P(cv-a)CO2水平为指导目标进行液体复苏。两组均在液体复苏6 h后持续观察28 d。比较两组的治疗情况、液体复苏前及液体复苏6 h后的生理指标及乳酸清除率和预后情况。结果治疗组住院时间短于对照组,差异有统计学意义(P<0.05);治疗组的去甲肾上腺素用量少于对照组,差异有统计学意义(P<0.05)。液体复苏6 h后两组的中心静脉压(CVP)、平均动脉压(MAP)、ScvO2水平高于复苏前,且治疗组的CVP、ScvO2水平及乳酸清除率高于对照组,差异均有统计学意义(P<0.05);液体复苏6 h后两组的MAP水平比较,差异无统计学意义(P>0.05)。两组的肺水肿发生率及28 d内病死率比较,差异无统计学意义(P>0.05)。结论P(cv-a)CO2联合ScvO2为监测指标指导感染性休克患者液体复苏能有效提高液体复苏质量,提升治疗效果,缩短住院时间,减少相关用药量,且患者液体复苏后的肺水肿发生率并未升高,安全性好。

Objective To explore the clinical value of venous-arterial carbon dioxide partial pressure difference(P[cv-a]CO2)and venous oxygen saturation(ScvO2)monitoring in septic shock.Methods From October 2018 to October 2020,86 patients with septic shock admitted to Jingdezhen Second People′s Hospital,Jiangxi Province were selected as the research objects.They were divided into the control group(43 cases)and the treatment group(43 cases)using random number table method.Patients in the control group used ScvO2 level as the guiding target for fluid resuscitation,Patients in the treatment group used the individual ScvO2 level combined with P(cv-a)CO2 level as the guiding target for fluid resuscitation.Patients in both groups were continuously observed for 28 days after fluid resuscitation for 6 hours.the treatment of the two groups of patients,physiological indicators,lactic acid clearance rate and prognosis before fluid resuscitation and 6 hours after fluid resuscitation were compared.Results The length of stay in the treatment group was shorter than that of the control group,and the difference was statistically significant(P<0.05);the dosage of Norepinephrine of the treatment group was less than that of the control group,and the difference was statistically significant(P<0.05).After 6 hours of resuscitation,the central venous pressure(CVP),mean arterial pressure(MAP),and ScvO2 levels of the two groups were higher than those before resuscitation,and the CVP,ScvO2 levels and lactate clearance rate of the treatment group were higher than those of the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in MAP level between the two groups of patients after 6 hours of fluid resuscitation(P>0.05);the differences in the incidence of pulmonary edema and mortality within 28 days between the two groups were not statistically significant(P>0.05).Conclusion P(cv-a)CO2 combined with ScvO2 is used as a monitoring indicator to guide patients with septic shock to perform fluid resuscitation,which can effectively improve the quality of fluid resuscitation,improve the treatment effect,shorten the hospital stay,reduce the amount of related medications,and the incidence of pulmonary edema after fluid resuscitation no increase,good security.