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中心静脉血氧饱和度联合中心静脉—动脉血二氧化碳分压差在指导感染性休克液体复苏中的应用

2017-09-23林爽罗彬张静

中外医疗 2017年20期
关键词:感染性休克

林爽++罗彬++张静

DOI:10.16662/j.cnki.1674-0742.2017.20.020

[摘要] 目的 研究中心靜脉血氧饱和度(ScvO2)联合中心静脉-动脉血二氧化碳分压差[P(cv-a)CO2]监测在指导感染性休克病人液体复苏中的意义。方法 根据液体复苏的目标,方便选取2015年3月—2017年3月新疆维吾尔自治区人民医院重症医学科(ICU)收治的98例感染性休克患者随机分为两组,A组[中心静脉压8~12 mmHg,平均动脉压>65 mmHg,尿量>0.5 mL/(kg·h)],B组[中心静脉压8~12 mmHg,平均动脉压>65 mmHg,尿量>0.5 mL/(kg·h),ScvO2≥70%,P(cv-a)CO2<6 mmHg],比较两组的疗效。结果B组发生MODS的比例为30.61%,低于A组(48.98%),差异有统计学意义(P<0.05),B组ICU病死率为18.37%,低于A组(30.61%),但差异无统计学意义(P>0.05), B组患者机械通气时间(8.54±6.13)d、ICU住院天数(10.01±7.16)d及ICU费用(8.23±3.35)万元较A组少,差异有统计学意义(P<0.05)。 结论 应用ScvO2联合P(cv-a)CO2监测指导液体复苏可以降低感染性休克患者MODS的发生率,减少机械通气时间、ICU住院天数及费用。

[关键词] 感染性休克;液体复苏;中心静脉血氧饱和度;中心静脉-动脉血二氧化碳分压差

[中图分类号] R541 [文献标识码] A [文章编号] 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

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