动静脉血二氧化碳分压差评价感染性休克患者疾病严重程度及预后的意义.docVIP

动静脉血二氧化碳分压差评价感染性休克患者疾病严重程度与预后的意义摘要?目的 探讨动静脉血二氧化碳分压差［P(cv-a)CO2］判断感染性休克患者疾病严重程度与预后的价值。 方法选取感染性休克患者45例，依据基线时［P(cv-a)CO2］水平将患者分为高［P(cv-a)CO2］组［P(cv-a)CO2］≥6 mm Hg；1 mm Hg=0.133 kPa］与低［P(cv-a)CO2］组［P(cv-a)CO2］6 mm Hg］，入组后立即采用早期目标指导性治疗（EGDT），观察2组患者血流动力学及氧代谢、6 h EGDT达标率、ICU病死率及28 d病死率等。 结果? 与高［P(cv-a)CO2］组比，低［P(cv-a)CO2］组患者基线时心指数、氧输送（DO2）、中心静脉血氧饱和度及24 h心指数、24 h DO2较高，乳酸水平［（3.4±2.1） mmol/L比（5.7±4.5）mmol/L］较低（P0.05），24 h序贯器官衰竭评估(SOFA)分值［（7.8±2.0）分比（9.8±2.0）分］显著下降（P0.05），ΔSOFA分值［（0.7±1.8）分比（-0.4±1.1）分］、6 h EGDT达标率（83.3%比53.3%）较高（P0.05），2组患者ICU病死率及28 d病死率差异无统计学意义（P0.05）。 结论 ［P(cv-a)CO2］是判断感染性休克患者组织灌注与疾病严重程度的具有重要意义的临床指标。关键词： 休克?? 脓毒性?? 动静脉血二氧化碳分压差?? 疾病严重程度?? 预后??Abstract： Objective? To assess the value of central venous-to-arterial carbon dioxide difference ［P(cv-a)CO2］ in evaluation of disease severity and prognosis in patients with septic shock. Methods? There were 45 consecutive resuscitated septic shock patients from April 2009 to October 2010 included immediately after their admission into our ICU. The patients were divided into low ［P(cv-a)CO2］ group and high［P(cv-a)CO2］ group according to a threshold of 6 mm Hg (1 mm Hg=0.133 kPa). All patients were treated by early goal directed therapy (EGDT). The parameters of hemodynamics, lactate clearance rate, the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, the sequential organ failure assessment (SOFA) score, 6 h rate of EGDT achievement, the ICU mortality and 28 days in-hospital mortality were recorded for all patients. Results? There were 30 patients in the low［P(cv-a)CO2］ group, and 15 in the high ［P(cv-a)CO2］group. There were no significant differences between low［P(cv-a)CO2］ and high ［P(cv-a)CO2］patients in age, APACHE score and SOFA score (all P0.05). Compared with the high ［P(cv-a)CO2］group, the low［P(cv-a)CO2］ group had higher cardiac index(CI) and 24 h CI, higher delivery O2(DO2) and 24 h DO2, higher central venous oxygen saturation(ScvO2) ［(74±9) % vs (67±8)%］, lower lactate ［(3.4±2.1) mmol/L vs