林爽++羅彬++張靜

DOI：10.16662/j.cnki.1674-0742.2017.20.020

[摘要] 目的 研究中心靜脈血氧飽和度（ScvO2）聯(lián)合中心靜脈-動(dòng)脈血二氧化碳分壓差[P（cv-a）CO2]監(jiān)測(cè)在指導(dǎo)感染性休克病人液體復(fù)蘇中的意義。方法 根據(jù)液體復(fù)蘇的目標(biāo)，方便選取2015年3月—2017年3月新疆維吾爾自治區(qū)人民醫(yī)院重癥醫(yī)學(xué)科（ICU）收治的98例感染性休克患者隨機(jī)分為兩組，A組[中心靜脈壓8～12 mmHg，平均動(dòng)脈壓>65 mmHg，尿量>0.5 mL/（kg·h）]，B組[中心靜脈壓8～12 mmHg，平均動(dòng)脈壓>65 mmHg，尿量>0.5 mL/（kg·h），ScvO2≥70%，P（cv-a）CO2<6 mmHg]，比較兩組的療效。結(jié)果B組發(fā)生MODS的比例為30.61%，低于A組（48.98%），差異有統(tǒng)計(jì)學(xué)意義（P<0.05），B組ICU病死率為18.37%，低于A組（30.61%），但差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）， B組患者機(jī)械通氣時(shí)間（8.54±6.13）d、ICU住院天數(shù)（10.01±7.16）d及ICU費(fèi)用（8.23±3.35）萬(wàn)元較A組少，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。 結(jié)論 應(yīng)用ScvO2聯(lián)合P（cv-a）CO2監(jiān)測(cè)指導(dǎo)液體復(fù)蘇可以降低感染性休克患者M(jìn)ODS的發(fā)生率，減少機(jī)械通氣時(shí)間、ICU住院天數(shù)及費(fèi)用。

[關(guān)鍵詞] 感染性休克；液體復(fù)蘇；中心靜脈血氧飽和度；中心靜脈-動(dòng)脈血二氧化碳分壓差

[中圖分類號(hào)] R541 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-0742（2017）07（b）-0020-03

Application of ScvO2 and P（cv-a）CO2 in Guiding the Recovery of Infectious Shock Fluid

LIN Shuang1，LUO Bin2， ZHANG Jing3

1.First Intensive Care Unit， Xinjiang Uygur Autonomous Region people's Hospital， Urumqi， Xinjiang， 830000 China；2.ICU， Fifth Affiliated Hospital of Xinjiang Medical University， Urumqi， Xinjiang， 830000 China

[Abstract] Objective To research the significance of ScvO2 and P（cv-a）CO2 in guiding the recovery of infectious shock fluid. Methods 98 cases of patients with infective shock in ICU in our hospital from March 2015 to March 2017 were convenient selected and randomly divided into two groups， including group A[central venous pressure 8～12 mmhg，mean arterial pressure>65 mmHg，urinary volume >0.5 mL/（kg·h） and group B （central venous pressure 8～12 mmHg， mean arterial pressure>65 mmHg，urinary volume >0.5 mL/（kg·h）， ScvO2≥70%，P（cv-a）CO2<6 mmHg]， and the curative effect was compared between the two groups. Results The occurrence ratio of MODS in the group B was lower than that in the group A（30.61% vs 48.98%），and the difference was statistically signficant（P<0.05）， and the ICU morbidity was lower than that in the group A，（18.37% vs 30.61%）， and the difference was not statistically signfiicant（P>0.05）， and the duration of mechanical ventilation， ICU legnth of stay and ICU cost in the group B were respectively （8.54±6.13）d， （10.01±7.16）d and （82.3±33.5） thousand yuan， which were lower than those in the group A， and the differences were statistically significant（P<0.05）. Conclusion The application of ScvO2 and P（cv-a）CO2 in guiding the fluid recovery can reduce the incidence rate of MODS of infective shock patients and reduce the duration of mechanical ventilation， ICU length of stay and ICU cost.

[Key words] Infective shock； Fluid recovery； ScvO2； P（cv-a）CO2endprint