中心静脉-动脉血二氧化碳分压差联合中心静脉血氧饱和度指导感染性休克患者液体复苏的应用效果及预后的危险因素分析

Central Venous-Arterial Carbon Dioxide Partial Pressure Difference Combined with Central Venous Oxygen Saturation to Guide the Application Effect of Fluid Resuscitation in Patients with Septic Shock and Analysis of Risk Factors for Prognosis

目的:探讨中心静脉-动脉血二氧化碳分压差[P(cv-a)CO_(2)]联合中心静脉血氧饱和度(ScvO_(2))指导感染性休克患者液体复苏的应用效果及预后的危险因素。方法:选取2020年1月-2021年12月我院收治的230例感染性休克患者,按照随机数字表法分为对照组(n=115,以ScvO_(2)为目标指导液体复苏)和观察租[n=115,P(cv-a)CO_(2)联合ScvO_(2)指导液体复苏],比较两组复苏前、复苏6 h后的相关监测指标,比较两组住院期间治疗相关指标。此外,根据入院后28 d生存预后将患者分为死亡组和生存组,采用多因素Logistic回归分析感染性休克患者死亡的危险因素。结果:复苏6 h后,两组患者的平均动脉压(MAP)、中心静脉压(CVP)、ScvO_(2)、心脏指数(CI)较复苏前升高,且观察组高于对照组(P<0.05),两组患者的血肌酐(Scr)水平、急性生理学与慢性健康状况(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分较复苏前降低,且观察组低于对照组(P<0.05);复苏6 h后观察组的6 h平均入液量、乳酸清除率高于对照组(P<0.05)。观察组ICU入住时间、机械通气时间、住院时间较对照组短(P<0.05)。单因素分析结果显示,相较于生存组患者,死亡组患者的年龄更大、APACHEⅡ评分、SOFA评分更高、机械通气时间、入住ICU时间、住院时间更久、CI、血酸清除率、ScvO_(2)更低(P<0.05)。多因素Logistic回归分析结果显示,APACHEⅡ评分≥30分、SOFA评分≥8分、血乳酸清除率<30%、ScvO_(2)<53%是感染性休克患者死亡的危险因素(P<0.05)。结论:P(cv-a)CO_(2)联合ScvO_(2)指导感染性休克患者液体复苏效果明显,有利于提高复苏作用和改善患者预后。较高的APACHEⅡ评分、SOFA评分以及较低的血乳酸清除率、ScvO_(2)是感染性休克患者不良预后的危险因素,临床应针对性干预。

Objective:To explore the effect of central venous-artial carbon dioxide difference(P(cv-a)CO_(2))combined with central venous oxygen saturation(ScvO_(2))to guide fluid resuscitation and risk factors for prognosis in patients with septic shock.Methods:From January 2020 to December 2021,230 patients with septic shock who were treated in our hospital from January 2020 to December 2021 were selected,they were divided into a control group(n=115,with ScvO_(2)as the target to guide fluid resuscitation)and an observation group(n=115,P(cv-a)CO_(2)combined with ScvO_(2)to guide fluid resuscitation)according to the random number table method.The related monitoring indexes before and 6h after resuscitation were compared between the two groups,and the related indexes of treatment during hospitalization were compared between the two groups.In addition,according to the survival prognosis 28 days after admission,the patients were divided into death group and survival group.Multivariate logistic regression was used to analyze the risk factors of death in patients with septic shock.Results:6 h after resuscitation,the mean arterial pressure(MAP),central venous pressure(CVP),ScvO_(2)and cardiac index(CI)of the two groups were higher than those before resuscitation,and the levels of serum creatinine(Scr),acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure score(SOFA)of the observation group were lower than those before resuscitation(P<0.05),and the observation group was lower than the control group(P<0.05).6 h after fluid resuscitation,the 6 h average liquid inflow and lactate clearance rate of the observation group were higher than those of the control group(P<0.05).The ICU stay time,mechanical ventilation time and hospitalization time of the observation group were shorter than those of the control group(P<0.05).Univariate analysis showed that compared with the survival group,the patients in the death group were older,had higher APACHEⅡscore,SOFA score,mechanical ventilation time,ICU stay time,longer hospitalization time,CI,blood acid clearance rate and ScvO_(2)lower(P<0.05).Multivariate Logistic regression analysis showed that APACHEⅡscore≥30 scores,SOFA score≥8 scores,blood lactate clearance rate<30%and ScvO_(2)<53%were the risk factors of death in patients with septic shock(P<0.05).Conclusions:P(cv-a)CO_(2)combined with ScvO_(2)has a significant effect on guiding fluid resuscitation in patients with septic shock,which is beneficial to improve the resuscitation effect and prognosis of patients.High APACHEⅡscore,SOFA score,low blood lactic acid clearance rate and ScvO_(2)are risk factors for poor prognosis in patients with septic shock,and clinical intervention should be targeted.