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中华重症医学电子杂志 ›› 2021, Vol. 07 ›› Issue (02): 137 -141. doi: 10.3877/cma.j.issn.2096-1537.2021.02.008

临床研究 上一篇    下一篇

ScvO 2和Pcv-aCO 2在脓毒性休克早期目标指导治疗中的价值
赵国敏 1, 陆非平 1 , ( )   
  1. 1. 100038 首都医科大学附属北京世纪坛医院重症医学科
  • 收稿日期:2021-01-04 出版日期:2021-05-28
  • 通信作者: 陆非平

Values of central venous oxygen saturation and difference of central venous-arterial partial pressure of carbon dioxide in early goal-directed treatment in patients with septic shock

Guomin Zhao 1, Feiping Lu 1( )   

  1. 1. Department of Critical Care Medicine, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
  • Received:2021-01-04 Published:2021-05-28
  • Corresponding author: Feiping Lu
目的

探讨以中心静脉血氧饱和度(ScvO2)和静脉-动脉血二氧化碳分压差(Pcv-aCO2)为早期目标指导治疗(EGDT)靶点在脓毒性休克治疗中的价值。

方法

采用前瞻性研究方法,选择2018年6月至2020年6月在首都医科大学附属北京世纪坛医院ICU住院治疗的脓毒性休克患者。所有患者入住ICU后立即按脓毒症治疗指南要求给予EGDT治疗。根据转入ICU后6 h的ScvO2及Pcv-aCO2水平将患者分为高Pcv-aCO2组(ScvO2≥0.7且Pcv-aCO2≥6 mmHg,1 mmHg=0.133 kPa);低Pcv-aCO2组(ScvO2 ≥0.7且Pcv-aCO2<6 mmHg)。观察2组患者血流动力学特点、病情严重程度及预后差异。

结果

共入选74例脓毒性休克患者,其中高Pcv-aCO2组28例,低Pcv-aCO2组46例。EGDT后高Pcv-aCO2组较低Pcv-aCO2组心排血指数(CI)、每搏量指数(SVI)明显降低,血管外肺水指数(EVLWI)明显升高;转入ICU后6、24、48 h(T6、T24、T48)急性生理学与慢性健康状况(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分、血乳酸均显著升高;ICU住院时间明显延长,ICU病死率显著增高,差异均有统计学意义(P<0.05)。

结论

脓毒性休克患者ScvO2达标后,以Pcv-aCO2<6 mmHg为EGDT靶点可改善患者的组织灌注及病情严重程度,降低ICU脓毒性休克患者病死率;增加CI可能有助于降低Pcv-aCO2

Objective

To evaluate the value of early goal-directed treatment (EGDT) with the target of central venous oxygen saturation (ScvO2) and difference of central venous–arterial partial pressure of carbon dioxide (Pcv-aCO2) in patients with septic shock.

Methods

A prospective study was conducted from Jun 2018 to Jun 2020 which enrolled 74 septic shock patients admitted to Beijing Shijitan Hospital affiliated Capital Medical University. EGDT was performed in all the patients immediately after enrollment with the target of ScvO2 ≥0.7. All patients were divided into two groups by the values of Pcv-aCO2 at 6 hours after ICU admission. High Pcv-aCO2 group with ScvO2 ≥0.7 and Pcv-aCO2 ≥6 mmHg, Low Pcv-aCO2 group with ScvO2 ≥0.7 and Pcv-aCO2<6 mmHg. Then the parameters of hemodynamics, the acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, the sequential organ failure assessment (SOFA) score, lactate and outcome of the patients in different groups were collected.

Results

74 cases were included, among which 28 in high Pcv-aCO2 group and 46 in low Pcv-aCO2 group. Compared with the low Pcv-aCO2 group, the high Pcv-aCO2 group had lower cardiac index (CI) and stroke volume index (SVI), higher extravascular lung water index (EVLWI). The APACHEⅡ score, SOFA score, blood lactate level in high Pcv-aO2 group were significantly higher at 6, 24, 48 hours after ICU admission. The duration of ICU stay, ICU mortality in high Pcv-aCO2 group was significantly higher. The differences were all statistically significant (P<0.05).

Conclusion

Pcv-aCO2<6 mmHg as EGDT target can improve tissue perfusion and severity of patients with septic shock after reaching the standard of ScvO2. Increasing cardiac ejection function may reduce the Pcv-aCO2.

表1 2组脓毒性休克患者基线资料比较
表2 2组脓毒性休克患者EGDT后血流动力学参数比较(
x ˉ
±s)
表3 2组脓毒性休克患者疾病严重程度与乳酸水平比较(
x ˉ
±s)
表4 2组脓毒性休克患者ICU住院时间及预后指标比较
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