目的探讨中心静动脉血二氧化碳分压差（Pcv—aCO2）和早期乳酸清除率在评估感染性休克患者预后中的临床意义。方法选取2010-01—2013—10收住我院重症医学科的82例经早期目标导向治疗（EGDT）达标的感染性休克患者进行前瞻性观察研究，...目的探讨中心静动脉血二氧化碳分压差（Pcv—aCO2）和早期乳酸清除率在评估感染性休克患者预后中的临床意义。方法选取2010-01—2013—10收住我院重症医学科的82例经早期目标导向治疗（EGDT）达标的感染性休克患者进行前瞻性观察研究，记录入院6hPcv—aCO2及患者入院后第-个24h急性生理学和慢性健康状况评分系统Ⅱ（acute physiology and chronic health evaluationⅡ，APACHEⅡ）评分和全身性感染相关性器官衰竭（SOFA）评分；并记录入院时、人院6h、入院24h动脉血乳酸，计算早期乳酸清除率；以入院6hPcv—aCO2高低分为两组：A组（Pcv—aCO2〈6mmHg）和B组（Pcv—aCO2≥6mmHg），比较两组患者乳酸清除率、SOFA评分及病死率。以6h乳酸清除率高低分为两组：c组（乳酸清除率≤10％）和D组（乳酸清除率〉10％），比较两组患者的28天病死率。根据28天病程转归分为死亡组（32例）和存活组（50例），比较两组患者不同时间动脉血乳酸浓度、APACHEⅡ评分。结果B组较A组乳酸清除率低，SOFA评分及病死率高，入院6hPcv—aCO2与6h乳酸清除率存在负相关（r=-0．324，P=0．003）。D组病死率低于C组（P〈0．05）。存活组APACHEⅡ评分较死亡组高，而入院时、6h、24h动脉血乳酸浓度均低于死亡组（P〈0．05）。结论6hPcv—aC02和6h乳酸清除率可作为判断感染性休克患者预后的指标。展开更多
Objective. Arterial oxygen saturation (SaO2) and arterial carbon dioxide partial pressure (PaCO2) are 2 of the most important respiratory parameters in the treatment of critically ill neonates. Noninvasive monitoring ...Objective. Arterial oxygen saturation (SaO2) and arterial carbon dioxide partial pressure (PaCO2) are 2 of the most important respiratory parameters in the treatment of critically ill neonates. Noninvasive monitoring of these parameters is desirable for continuous estimating of the respiratory status and reducing blood loss because of repeated blood gas analyses. Transcutaneous measurement of PCO2 (PtcCO2) represents a simple and noninvasive technique for continuous monitoring of ventilation. However, sensor preparation, positioning, taping, and repeated changes of the sensor location make the handling difficult and complicate its use in the neonatal care unit. Recently, a new sensor for combined assessment o f pulse oximetry oxygen saturation (SpO2) and PtcCO2 has been introduced (TOSCA Monitor; Linde Medical Sensors, Basel, Switzerland). The monitor combines pulse oximetry and PtcCO2 measurement in a single ear sensor, which works at 42°C to enhance blood flow in capillaries below the sensor. Methods. In a prospective, open, nonrandomized study of 60 ill neonates, the new ear sensor for combined assessment of SpO2 and PtcCO2 at 42°C was tested. The sensor was adapted to the ear of a neonate with a Varihesive layer (Conva Tec; Princeton, NJ). Data obtained from the ear sensor were compared with SpO2 Finger/Heel, SaO2, and PaCO2 obtained from arterial blood gas in 30 patients and with a capillary blood gas in an additional 30 patients using Bland Altman bias analysis. Data are presented as median (range). Results. The postconceptional age of the patients was 38.3 weeks (range: 28 5/7-40 5/7) in the arterial group and 37.9 weeks (range: 29 6/7-41 0/7) in the capillary group. Age of the newborns studied was 3.5 days (range: 1-28) in the arterial blood sample group (n = 30) and 6 days (range: 2-28) in the capillary blood sample group (n = 30). Patient weight was 3.02 kg (range: 1.5-4.5) in the arterial group and 2.76 kg (range: 1.0-3.71) in the other group. Three patients had weights of < 1500 g. Twenty-one of 60 patients were conventionally ventilated, 4 patients received high-freque- ncy oscillation, and 35 were not ventilated. Mean difference (bias) and precision (2 SD of the mean difference) between PtcCO2TOSCA and PaCO2 were -0.44 kPa (-3.21 mm Hg) and 0.82 kPa (6.02 mm Hg) and between PtcCO2TOSCA and PcapCO2 were -0.09 kPa (-0.67mm Hg) and 1.11 kPa (8.07 mm Hg), respectively. SpO2 assessment by the TOSCA revealed slightly higher values compared with SaO2 (bias: -0.48%), whereas SpO2Finger/Heel values were slightly lower than SaO2 (bias: 0.52%). Conclusion. The TOSCA monitor with the ear sensor adapted to ears of neonates allows reliable estimation of SaO2 and PaCO2. A potential benefit is the reduction in motion artifacts because of less head movement in new-borns and that onl y a single cable leads form the patient to the monitor. In addition, the sensor is not removed for chest radiograph or for nursing the infant on his or her parent’s lap. Long-term studies in a large population with continuous measurements are required to confirm these preliminary findings and to elucidate the benefits in detection of respiratory deterioration and the potential side effects of this sensor.展开更多
目的 探讨中心静脉-动脉血二氧化碳分压差值（Pcv-aCO2）在评估严重脓毒症患者预后中的临床价值.方法收集入住我院ICU 96例经过早期液体复苏治疗后中心静脉血氧饱和度（ScvO2）≥70%的严重脓毒症患者的APACHEⅡ评分、ScvO2、6 h Pcv-aCO...目的 探讨中心静脉-动脉血二氧化碳分压差值（Pcv-aCO2）在评估严重脓毒症患者预后中的临床价值.方法收集入住我院ICU 96例经过早期液体复苏治疗后中心静脉血氧饱和度（ScvO2）≥70%的严重脓毒症患者的APACHEⅡ评分、ScvO2、6 h Pcv-aCO2、6 h动脉血乳酸清除率和预后的相关资料.按预后不同将患者分为存活组（n=61）和死亡组（n=35）;以Pcv-aCO2 6 mm Hg为界分为高Pcv-aCO2组（≥6 mm Hg,n=40）和低Pcv-aCO2组（〈6 mm Hg,n=56）,比较存活组与死亡组、高Pcv-aCO2组与低Pcv-aCO2组之间相关数值的差异.结果 各组治疗前APACHEⅡ评分、ScvO2、动脉血乳酸比较差异均无统计学意义（P〉0.05 ）.存活组6 h Pcv-aCO2（3.15±1.54） mm Hg,明显低于死亡组[（8.34±1.89）mm Hg,P〈0.01];低Pcv-aCO2组病死率（28.57%）明显低于高Pcv-aCO2组（47.50%,P〈0.05）.存活组和低Pcv-aCO2组6 h血乳酸清除率（26.54±11.21）%和（28.16±12.39）%,明显高于死亡组[（14.96±10.93）%]和高Pcv-aCO2组[（13.82±13.54）%,均P〈0.01].6 h Pcv-aCO2与6 h血乳酸清除率呈负相关（r=-0.719,P〈0.01）.结论早期Pcv-aCO2可作为评估严重脓毒症患者预后的一个指标.展开更多
文摘目的探讨中心静动脉血二氧化碳分压差（Pcv—aCO2）和早期乳酸清除率在评估感染性休克患者预后中的临床意义。方法选取2010-01—2013—10收住我院重症医学科的82例经早期目标导向治疗（EGDT）达标的感染性休克患者进行前瞻性观察研究，记录入院6hPcv—aCO2及患者入院后第-个24h急性生理学和慢性健康状况评分系统Ⅱ（acute physiology and chronic health evaluationⅡ，APACHEⅡ）评分和全身性感染相关性器官衰竭（SOFA）评分；并记录入院时、人院6h、入院24h动脉血乳酸，计算早期乳酸清除率；以入院6hPcv—aCO2高低分为两组：A组（Pcv—aCO2〈6mmHg）和B组（Pcv—aCO2≥6mmHg），比较两组患者乳酸清除率、SOFA评分及病死率。以6h乳酸清除率高低分为两组：c组（乳酸清除率≤10％）和D组（乳酸清除率〉10％），比较两组患者的28天病死率。根据28天病程转归分为死亡组（32例）和存活组（50例），比较两组患者不同时间动脉血乳酸浓度、APACHEⅡ评分。结果B组较A组乳酸清除率低，SOFA评分及病死率高，入院6hPcv—aCO2与6h乳酸清除率存在负相关（r=-0．324，P=0．003）。D组病死率低于C组（P〈0．05）。存活组APACHEⅡ评分较死亡组高，而入院时、6h、24h动脉血乳酸浓度均低于死亡组（P〈0．05）。结论6hPcv—aC02和6h乳酸清除率可作为判断感染性休克患者预后的指标。
文摘Objective. Arterial oxygen saturation (SaO2) and arterial carbon dioxide partial pressure (PaCO2) are 2 of the most important respiratory parameters in the treatment of critically ill neonates. Noninvasive monitoring of these parameters is desirable for continuous estimating of the respiratory status and reducing blood loss because of repeated blood gas analyses. Transcutaneous measurement of PCO2 (PtcCO2) represents a simple and noninvasive technique for continuous monitoring of ventilation. However, sensor preparation, positioning, taping, and repeated changes of the sensor location make the handling difficult and complicate its use in the neonatal care unit. Recently, a new sensor for combined assessment o f pulse oximetry oxygen saturation (SpO2) and PtcCO2 has been introduced (TOSCA Monitor; Linde Medical Sensors, Basel, Switzerland). The monitor combines pulse oximetry and PtcCO2 measurement in a single ear sensor, which works at 42°C to enhance blood flow in capillaries below the sensor. Methods. In a prospective, open, nonrandomized study of 60 ill neonates, the new ear sensor for combined assessment of SpO2 and PtcCO2 at 42°C was tested. The sensor was adapted to the ear of a neonate with a Varihesive layer (Conva Tec; Princeton, NJ). Data obtained from the ear sensor were compared with SpO2 Finger/Heel, SaO2, and PaCO2 obtained from arterial blood gas in 30 patients and with a capillary blood gas in an additional 30 patients using Bland Altman bias analysis. Data are presented as median (range). Results. The postconceptional age of the patients was 38.3 weeks (range: 28 5/7-40 5/7) in the arterial group and 37.9 weeks (range: 29 6/7-41 0/7) in the capillary group. Age of the newborns studied was 3.5 days (range: 1-28) in the arterial blood sample group (n = 30) and 6 days (range: 2-28) in the capillary blood sample group (n = 30). Patient weight was 3.02 kg (range: 1.5-4.5) in the arterial group and 2.76 kg (range: 1.0-3.71) in the other group. Three patients had weights of < 1500 g. Twenty-one of 60 patients were conventionally ventilated, 4 patients received high-freque- ncy oscillation, and 35 were not ventilated. Mean difference (bias) and precision (2 SD of the mean difference) between PtcCO2TOSCA and PaCO2 were -0.44 kPa (-3.21 mm Hg) and 0.82 kPa (6.02 mm Hg) and between PtcCO2TOSCA and PcapCO2 were -0.09 kPa (-0.67mm Hg) and 1.11 kPa (8.07 mm Hg), respectively. SpO2 assessment by the TOSCA revealed slightly higher values compared with SaO2 (bias: -0.48%), whereas SpO2Finger/Heel values were slightly lower than SaO2 (bias: 0.52%). Conclusion. The TOSCA monitor with the ear sensor adapted to ears of neonates allows reliable estimation of SaO2 and PaCO2. A potential benefit is the reduction in motion artifacts because of less head movement in new-borns and that onl y a single cable leads form the patient to the monitor. In addition, the sensor is not removed for chest radiograph or for nursing the infant on his or her parent’s lap. Long-term studies in a large population with continuous measurements are required to confirm these preliminary findings and to elucidate the benefits in detection of respiratory deterioration and the potential side effects of this sensor.
文摘目的 探讨中心静脉-动脉血二氧化碳分压差值（Pcv-aCO2）在评估严重脓毒症患者预后中的临床价值.方法收集入住我院ICU 96例经过早期液体复苏治疗后中心静脉血氧饱和度（ScvO2）≥70%的严重脓毒症患者的APACHEⅡ评分、ScvO2、6 h Pcv-aCO2、6 h动脉血乳酸清除率和预后的相关资料.按预后不同将患者分为存活组（n=61）和死亡组（n=35）;以Pcv-aCO2 6 mm Hg为界分为高Pcv-aCO2组（≥6 mm Hg,n=40）和低Pcv-aCO2组（〈6 mm Hg,n=56）,比较存活组与死亡组、高Pcv-aCO2组与低Pcv-aCO2组之间相关数值的差异.结果 各组治疗前APACHEⅡ评分、ScvO2、动脉血乳酸比较差异均无统计学意义（P〉0.05 ）.存活组6 h Pcv-aCO2（3.15±1.54） mm Hg,明显低于死亡组[（8.34±1.89）mm Hg,P〈0.01];低Pcv-aCO2组病死率（28.57%）明显低于高Pcv-aCO2组（47.50%,P〈0.05）.存活组和低Pcv-aCO2组6 h血乳酸清除率（26.54±11.21）%和（28.16±12.39）%,明显高于死亡组[（14.96±10.93）%]和高Pcv-aCO2组[（13.82±13.54）%,均P〈0.01].6 h Pcv-aCO2与6 h血乳酸清除率呈负相关（r=-0.719,P〈0.01）.结论早期Pcv-aCO2可作为评估严重脓毒症患者预后的一个指标.
