摘要
目的研究微循环障碍对高龄脓毒性休克患者组织灌注和死亡率的影响。方法选取2018年5月~2019年8月到我院治疗的高龄脓毒性休克患者50例。当平均动脉压(MAP)、中心静脉压(CVP)、心指数(CI)达到目标时,根据患者的中心静脉-动脉血二氧化碳分压差/动脉-中心静脉血氧含量差(Pv-aCO2/Ca-vO2)和Pv-aCO2值,将患者分为对照组(Pv-aCO2/Ca-vO2<1.4mmHg/ml,20例)、低灌注组(Pv-aCO2/Ca-vO2>1.4mmHg/ml,且Pv-aCO2>6mmHg,18例)和正常灌注组(Pv-aCO2/Ca-vO2>1.4mmHg/ml,且Pv-aCO2<6mmHg,12例)。监测各组患者的体温、心率(HR)、CVP、MAP、CI、血红蛋白(Hb)、动脉血氧饱和度(SaO2)、中心静脉血氧饱和度(ScvO2)、急性生理与慢性健康(APACHE-Ⅱ)评分、动脉血乳酸(Lac),计算患者的6h和24h乳酸清除率(LCR)、28天死亡率。结果3组患者临床指标相比,体温、CVP、MAP、ScvO2差异无统计学意义(P>0.05),HR、Hb、CI、SaO2、APACHE-Ⅱ评分、动脉血乳酸值、6h和24h乳酸清除率、28天死亡率差异均有统计学意义(P<0.05);Kendall's tau-b相关性分析结果显示,死亡风险与灌注程度呈负相关(r=-0.434,P<0.05)。结论以Pv-aCO2/Ca-vO2与Pv-aCO2值评价的灌注程度与高龄脓毒性休克患者的预后呈明显负相关,临床上可通过检测Pv-aCO2/Ca-vO2和Pv-aCO2值,及早做出合理诊断。
Objective To study the effect of microcirculatory disturbance on tissue perfusion and mortality in elderly patients with septic shock.Methods 50 patients with septic shock treated in our hospital from May 2018 to Aug 2019 were selected.When the mean arterial pressure(MAP),central venous pressure(CVP),and cardiac index(CI)reached the target,according to the patients'central venous-arterial blood carbon dioxide partial pressure difference/arterial central venous blood oxygen content difference(Pv-aCO2/Ca-vO2)and Pv-aCO2 value,the patients were divided into control group(Pv-aCO2/Ca-vO2<1.4mmHg/ml,20 cases),low perfusion group(PvaCO2/Ca-vO2>1.4mmHg/ml,Pv-aCO2>6mmHg,18 cases)and normal perfusion group(Pv-aCO2/Ca-vO2>1.4mmHg/ml,…Pv-aCO2<6mmHg,12 cases).Monitored body temperature,heart rate(HR),CVP,MAP,CI,hemoglobin(Hb),arterial oxygen saturation(SaO2),central venous oxygen saturation(ScvO2),acute physiology and chronic health(APACHE-Ⅱ)score,arterial blood lactate(Lac),calculated 6h and 24h lactate clearance rate(LCR),28-day mortality.Results There were no significant differences in body temperature,CVP,MAP and ScvO2 among the three groups(P>0.05).HR,Hb,CI,SaO2,APACHE-Ⅱscore,lactic acid value in arterial blood,lactate clearance rate in 6h and 24h,and 28-day mortality had statistical significance(P<0.05).Kendall's tau-b correlation analysis showed that there was a negative correlation between the risk of death and the degree of perfusion(r=-0.434,P<0.05).Conclusion The degree of perfusion evaluated by Pv-aCO2/Ca-vO2 and Pv-aCO2 values is significantly negatively correlated with the prognosis of elderly patients with septic shock.Clinical diagnosis can be made as early as possible by detecting…Pv-aCO2/Ca-vO2 and Pv-aCO2 values.
作者
尚宝朋
叶观宇
殷旭升
李志波
陈国祥
Shang Baopeng;Ye Guanyu;Yin Xusheng(Zhongshan Chenxinghai Hospital,Zhongshan 528415)
出处
《中国现代医药杂志》
2020年第2期6-9,共4页
Modern Medicine Journal of China
基金
广东省中山市卫计局项目(编号:2018J251)
