Abstract
Objective To investigate the clinical significance of central venous - to - arterial carbon dioxide difference (Pcv-aCO2 )in guiding the fluid management of septic patients and whether central venous blood oxygen saturation( ScvO2 ) combining Pcv-aCO2 could provide better guidance. Methods We enrolled 36 septic patients with severe sepsis and septic shock who were admitted into the Intensive Care Unit of the Fourth Hospital of Hebei Medical University from January 2012 to January 2013. After the patients were admitted into ICU,they were implanted with double cavity anti - infection central venous catheters, and fluid resuscitation treatment began immediately. At 0 h( T0),6 h( T6) and 24 h( T24) of fluid resuscitation,HR, RR,MAP,CVP,Lac,Scr,Hb,PT and WBC were recorded;at T0,T6 and T24,radial artery blood gas analysis was made (pH,PaO2 ,PaCO2 and the calculation of PaO2 / FiO2 and BE),and superior vena cava blood gas analysis was made( pH, ScvO2 ,PcvCO2 and the calculation of Pcv-aCO2 ). According to 24 h ScvO2 and 24 h Pcv-aCO2 ,the subjects were divided into four groups:group 1( ScvO2 > 70% ,Pcv-aCO2 < 6 mm Hg),group 2( ScvO2 > 70% ,Pcv-aCO2 ≥6 mm Hg),group 3 (ScvO2≤70% ,Pcv-aCO2 < 6 mm Hg)and group 4(ScvO2≤70% ,Pcv-aCO2≥6 mm Hg). Comparison was made among the four groups in psychological index,biochemical criterion and blood gas analysis;24 h fluid intake and Lac clearance rate, mechanical ventilation days,ICU days,hospitalization days,ICU case fatality rate and 28 d case fatality rate were calculated. Results At different time points of fluid resuscitation,MAP,Scr and Hb did not change significantly( P > 0. 05);HR, CVP,Pcv-aCO2 ,ScvO2 ,pH,BE,Lac,PaO2 / FiO2 changed significantly(P < 0. 05);HR,Pcv-aCO2 ,Lac at T6 and T24 were lower than those at T0,while CVP,ScvO2 ,pH,BE and PaO2 / FiO2 were higher than those at T0( P < 0. 05);HR, Pcv-aCO2 and Lac at T24 were lower than those at T6,and CVP,ScvO2 ,BE and PaO2 / FiO2 at T24 were higher than those at T6(P < 0. 05). At T0,T6 and T24,Pcv-aCO2 had no linear correlation with Lac,BE and pH(P > 0. 05). At T0,T6 and T24,Pcv-aCO2 had negative correlation with ScvO2 ( r = - 0. 755, - 0. 920, - 0. 858;P < 0. 05 ). At T6 and T24, Pcv-aCO2 had negative correlation with Lac clearance rate at 6 h and Lac clearance rate at 24 h(r = - 0. 365, - 0. 864;P <0. 05). At T24,the 4 groups were not significantly different in MAP,HR,Hb,Scr,Lac,BE,pH,PaO2 / FiO2 and ScvO2 (P > 0. 05);the 4 groups were not significantly different in Pcv-aCO2 (P < 0. 05). At 24 h,the 4 groups were significantly different in the Lac clearance rate and fluid intake(P < 0. 01);group 2,group 3 and group 4 were lower than group 1 in Lac clearance rate and fluid intake(P < 0. 05). The 4 groups were not significantly different in mechanical ventilation days,ICU days,hospitalization days,ICU case fatality rate and 28 d case fatality rate(P > 0. 05). Conclusion Pcv-aCO2 could be used as an index to guide the fluid resuscitation of patients with severe sepsis and septic shock. ScvO2 combined with Pcv-aCO2 could be used to guide fluid management,and patients with both indexes reaching standard need the highest amount of fluid and their Lac clearance rate is highest. The combination could avoid fluid resuscitation cease due to pseudo normalization of ScvO2 .关键词
脓毒症/中心静脉血氧饱和度/中心静脉-动脉二氧化碳分压差Key words
Sepsis/Central venous oxygen saturation/Central to - venous arterial carbon dioxide difference分类
医药卫生
