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目的探讨中心静脉与动脉血二氧化碳分压差(Pcv-aCO_2)对感染性休克患者液体复苏治疗的指导意义。方法选取2014年9月到2015年10月在重症医学科住院的感染性休克患者50例,所有患者进行液体复苏早期目标导向治疗(EGDT)6 h内达标,根据Pcv-aCO_2水平将患者分为Pcv-aCO_2≥6 mm Hg组和Pcv-aCO_2<6mm Hg组,比较两组在EGDT 0、12、24 h的血流动力学指标、循环灌注指标、器官功能评价指标、预后指标的差异。分析患者在EGDT达标0、12、24 h的Pcv-aCO_2与动脉血乳酸(Lac)清除率的相关性。结果两组患者在EGDT 12 h和24 h时的心率、Lac逐渐下降(P均<0.05),平均动脉压、中心静脉压、氧合指数、血清肌酐水平逐渐上升(P均<0.05),除Pcv-aCO_2≥6 mm Hg组的Lac高于Pcv-aCO_2<6 mm Hg组外(P均<0.05),其余指标两组均无显著差异(P均>0.05)。Pcv-aCO_2≥6 mm Hg者的Lac清除率和总液体入量低于Pcv-aCO_2<6 mm Hg者(P均<0.05)。两组患者在EGDT达标后各时间点的中心静脉血氧饱和度(Scv O2)均无明显变化(P均>0.05)。患者EGDT达标0、12、24 h的Pcv-aCO_2与Lac清除率均呈负相关(r=-0.398,-0.416,-0.410,P均<0.05)。结论感染性休克患者在EGDT达标后的Scv O2无明显变化,而Pcv-aCO_2可做为复苏效果的评价指标。
Objective To investigate the guiding significance of Pcv-aCO 2 in the treatment of serous resuscitation in patients with septic shock. Methods Seventy patients with septic shock who were hospitalized in the Department of Critical Care Medicine from September 2014 to October 2015 were enrolled in this study. All patients were enrolled in the EGDT within 6 h. According to the level of Pcv-aCO 2, the patients were divided into Pcv-aCO_2≥6 mm Hg group and Pcv-aCO_2 <6 mm Hg group. The difference of hemodynamics, perfusion index, organ function evaluation index and prognosis index of EGDT at 0,12,24 h were compared between the two groups. The correlation between Pcv-aCO 2 and arterial lactate (Lac) clearance rate at 0, 12, 24 h after EGDT was evaluated. Results The heart rate and Lac of the two groups decreased gradually at 12 h and 24 h after EGDT (all P <0.05). The mean arterial pressure, central venous pressure, oxygenation index and serum creatinine increased gradually (P <0.05) Lac in Pcv-aCO_2≥6 mm Hg group was higher than that in Pcv-aCO_2 <6 mm Hg group (all P <0.05). There was no significant difference in other indexes between two groups (P> 0.05). Lac clearance and total fluid intake of Pcv-aCO_2≥6 mm Hg were lower than those of Pcv-aCO_2 <6 mm Hg (all P <0.05). There was no significant change in the central venous oxygen saturation (Scv O2) between the two groups after EGDT reached the standard (all P> 0.05). There was a negative correlation between Pcv-aCO 2 and Lac clearance rate at 0, 12, and 24 h after reaching EGDT (r = -0.398, -0.416, -0.410, P <0.05). Conclusions Scv O2 in patients with septic shock after EGDT is up-regulated has no significant change, while Pcv-aCO 2 can be used as the evaluation index of resuscitation efficacy.