脓毒性休克患者Cv-aCO2/Ca-vO2、 乳酸清除率与IVCrvi 的关系

Study on correlation between Cv-aCO2/Ca-vO2, LCR and IVCrvi in patients with septic shock

摘要:

目的 探讨脓毒性休克患者静脉- 动脉血二氧化碳含量差与动脉- 静脉血氧含量差的比值（CvaCO 2/Ca-vO2）、乳酸与下腔静脉内径呼吸变异指数（IVCrvi）的关系。方法 选取2016 年6 月—2018 年2 月 遵义市第一人民医院收治的66 例脓毒性休克患者，随机分为A 组（23 例）、B 组（21 例）及C 组（22 例）。采 用连续多普勒无创血液动力学监测仪记录患者血流动力学数据，在抗感染、早期复苏等基础上，A 组加用 Cv-aCO2/Ca-vO2<1.1 作为24 h 复苏终点指导治疗；B 组加用乳酸清除率>50% 作为24 h 复苏终点指导治 疗；C 组加用IVCrvi<30% 作为24 h 复苏终点指导治疗。观察3 组治疗前后急性生理学与慢性健康状况评估 Ⅱ（APACHE Ⅱ）评分、序贯器官衰竭评估（SOFA）评分、平均动脉压（MAP）、中心静脉压（CVP）、氧 气指数（PaO2/FiO2）、中心静脉血氧饱和度（ScvO2）、每搏量变异度（SVV）、心脏指数（CI）、外周血管阻 力指数（SVRI）、降钙素原（PCT）及28 d 病死率等变化。结果 3 组治疗前APACHE Ⅱ评分、SOFA 评分、 MAP、血乳酸水平及PCT 水平比较，差异无统计学意义（P >0.05）；3 组治疗6 h 后CVP 水平比较，差异有 统计学意义（P <0.05）；3 组MAP 值、达到目标MAP 所需液体量、PaO2/FiO2、心率（HR）及乳酸值比较， 差异无统计学意义（P >0.05）；3 组治疗24 h 后，中心静脉动脉二氧化碳分压差（Pcv-a CO2）、SVRI 及脑肽 钠比较，差异无统计学意义（P >0.05），而ScvO2、WBC 比较，差异有统计学意义（P <0.05）；3 组治疗7 d 后， CI、SVRI、氧输送（DO2）及PCT 比较，差异无统计学意义（P >0.05），而SVV 值比较，差异有统计学意义 （P <0.05）；3 组28 d 总CBP 时间、机械通气时间、住ICU 时间及28 d 病死率比较，差异无统计学意义（P >0.05）。 结论 Cv-aCO2/Ca-vO2、乳酸清除率与IVCrvi 有关。

Abstract:

Objective To explore the correlation between the ratio of the difference of carbon dioxide content in venous and arterial blood to the difference of oxygen content in arterial and venous (Cv-aCO2/Ca-vO2), the lactate clearance rate (LAC) and the respiratory variations index of inferior vena cava (IVCrvi) in patients with septic shock. Methods Totally 66 patients with septic shock treated from June 2016 to February 2018 in our hospital were randomly divided into group A (23 cases), group B (21 cases) and group C (22 cases). Using USCOM to record the patient’s hemodynamic data, based on anti-infection and early resuscitation, group A was treated with Cv-aCO2/ Ca-vO2 < 1.1 as the guide for the end point of 24-hour resuscitation; group B was treated with LCR > 50% to guide the end point of the 24-hour resuscitation; group C was treated with IVCrvi < 30% to guide the end point of the 24-hour resuscitation. The changes of APACHE II score, SOFA score, MAP, CVP, PaO2/FiO2, ScvO2, SVV, CI, SVRI, PCT, 28-day mortality and so on in patients before and after treatment were observed. Results There was no significant difference in SOFA score, MAP, levels of blood Lac level and PCT among three groups before treatment (P > 0.05); there was a significant difference in CVP after 6-hour treatment (P < 0.05). There was no significant difference in the values of MAP, the amount of fluid needed to reach the target MAP, PaO2/FiO2, HR and Lac among three groups (P > 0.05); after 24 hours of treatment, there was no significant difference in P (Cv-a) CO2, SVRI and brain peptide sodium (BNP) (P > 0.05), but there were significant differences in the values of ScvO2 and WBC (P < 0.05). After 7 days of treatment, there was no significant difference in CI, SVRI, DO2 and PCT among three groups (P > 0.05), but there was a significant difference in SVV (P < 0.05); there was no significant difference in total CBP time, mechanical ventilation time, ICU stay time and 28-day mortality among three groups (P > 0.05). Conclusions Cv-aCO2/Ca-vO2 and LCR have a positive correlation with IVCrvi.