ScvO的临床意义课件.ppt

研究结果——死亡率 Rivers E, Nguyen B, Havstad S, et a1．Early goal directed therapy in the treatment of severe sepsis and septic shock. N Eng J Med,2001,345:1368—1377. 进行ScvO2监测，达到EGDT目标，可使患者病死率下降16%（46.5% vs 30.5%）。 低ScvO2的预后差 2012 “拯救脓毒症运动”指南——早期复苏目标 MAP ≥65mmHg CVP 8~12mmHg , 机械通气12~15mmHg 尿量≥0.5ml/kg/h ScvO2 ≥ 70% or SvO2 ≥65% 感染性休克高ScvO2的预后 单因素分析结果 存活组与死亡组的ScvO2 该研究共纳入4家医院急诊科脓毒症患者619名，按EDGT复苏方案治疗，据ScvO2水平分为三组：低ScvO2组(＜70%)、正常ScvO2组(71~89%)、高组(90~100%)。比较住院死亡率并进行多因素分析 23% 25% 31% 初始ScvO2与死亡率 (81/351) (56/223) (14/45) 25/62 96/465 31/92 ScvO2在ACS 中的应用 该研究纳入患者43名，为收住CCU的急性冠脉综合征（ACS）并急性肺水肿或心源性休克患者，测定入室时、24h、48h的中心静脉和外周动脉血气，主要终点为致死性事件，次要终点为住院全因死亡率 Acta Cardiol Sin 2008;24:12633 结果：存活组与死亡组ScvO2的差异有显著性 Acta Cardiol Sin 2008;24:12633 所有患者ScvO2、SaO2的变化 存活患者ScvO2的变化 Acta Cardiol Sin 2008;24:12633 创伤患者的评估 Low central venous saturation predicts poor outcome in patients with brain injury after major trauma: a prospective observational study Alessandro Di Filippo*1, Chiara Gonnelli1, Lucia Perretta1,Rosario pina1, Marco Chiostri2, Gian Franco Gensini2 and Adriano Peris1 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine2009, 17:23 Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine2009, 17:23 ScvO2≤65%的患者住院时间延长，死亡率明显增加 急诊插管对重症患者ScvO2的影响 15min Hernandez et al. Critical Care2009, 13:R63 Hernandez et al. Critical Care2009, 13:R63 插管改善ScvO2的机制 插管前预充纯氧，溶解氧增加，氧供提高 插管时镇静与肌松使氧摄取减少而降低氧耗 初始机械通气减轻了过度通气，使pH升高而使氧离曲线右移，利于氧释放 围术期ScvO2的应用 患者资料 单因素分析 After multivariate analysis, mean ScvO2 value (OR 1.23 [95%CI 1.01 to 1.50], p = 0.037), hospital LOS (OR 0.75 [95% CI 0.59 to 0.94], p = 0.012), and SAPS II (OR 0.90 [95% CI 0.82 to 0.99], p = 0.029) were independently associated with postoperative complications. 多因素分析 低ScvO2与术后并发症相关 P=0.004 The optimal value of mean ScvO2 for discriminating between patients who did or did not develop complications was 73% (sensitivity72%, specificity 61%) ScvO2与乳酸在感染性休克中应用比较 Jones的研究显示：在感染性休克的早期目标性治疗中，乳酸清除率达标与ScvO2达标，两组的住院死亡率