ScvO2联合P(cv-a)CO2监测在感染性休克患者液体复苏中的指导意义及对预后的影响

doi:10.3969/j.issn.1002-1949.2019.10.004

Chinese Journal of Critical Care Medicine

2019, Vol. 39

Issue (10): 939-944 DOI: 10.3969/j.issn.1002-1949.2019.10.004

Meaning and effect of ScvO2 combined with P(cv-a)CO2 on fluid resuscitation in the patients with septic shock

Niu Xing-guo, Zhang Si-sen, Jiao Xian-fa, Guo Yu-hong, Wang Xiao-wen, Li Jin-xiu, Wang Hong-yu

Intensive Care Unit, Zhengzhou People′s Hospital, Zhengzhou 450003, China

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Abstract Objective To investigate the value of central venous oxygen saturation (ScvO2) combined with central venous-arterial blood carbon dioxide partial pressure difference ［P(cv-a)CO2］ in fluid resuscitation in the patients with septic shock. Methods A total of 94 patients with septic shock admitted to our hospital from January 2016 to February 2018 were enrolled in the study. They were randomly divided into the observation group and the control group(47 patients in each group). After the enrollment, the central venous catheter was routinely placed, and the fluid resuscitation was performed according to the clinical treatment guidelines. The control group was guided by ScvO2 as the target for fluid resuscitation, and the observation group was guided by ScvO2 combined with P(cv-a)CO2 to guide the fluid resuscitation. The changes of monitoring indexes ［CVP, MAP，ScvO2, cardiac index (CI), lactate clearance］, and the outcome of the disease ［acute physiology and chronic health status score (APACHE Ⅱ), sequential organ failure score (SOFA)］, basic treatment and prognosis of pulmonary edema, 28-day mortality were compared. Results ①Changes of monitoring indicators: CVP, MAP, ScvO2 and CI were not significantly different between the two groups before fluid resuscitation (P＞0.05); after 6 hours of fluid resuscitation, CVP, MAP, ScvO2 and CI in the two groups were better than those before fluid resuscitation (P＜0.05). The clearance rates of CVP, ScvO2, CI and lactic acid in the observation group were higher than those in the control group (P＜0.05). ②Prognosis: there was no significant difference in APACHE Ⅱ and SOFA between the two groups before fluid resuscitation (P＞0.05); APACHE Ⅱ and SOFA of the two groups after fluid resuscitation 6 hours were lower than those before fluid resuscitation (P＜0.05), and the observation group was lower than that of the control group (P＜0.05). ③Basic treatment conditions: ICU stay time (9.31±4.24) days, mechanical ventilation time (11.72±4.93) days in the observation group were shorter than those in the control group ［（13.27±5.01)d and（14.83±5.26）d, P＜0.05］, norepinephrine dosage (13.01±5.21) mg and dobutamine dosage (87.26±28.34) mg were less than those in the control group ［（16.73±6.44)mg and（109.47±31.23）mg,P＜0.05］. ④Prognosis: the incidence of pulmonary edema in the observation group was 19.15% (9/47) and 14.89% (7/47) in the control group (P＞0.05); the 28-day mortality was 6.38% (3/47) and 14.89% (7/47) in the control group(P＞0.05). Conclusion The combined monitoring of ScvO2 and P(cv-a)CO2 has important guiding significance in fluid resuscitation of septic shock patients. It is helpful to further ensure effective resuscitation, improve therapeutic effect, shorten ICU stay time and mechanical ventilation time, and does not increase the risk of pulmonary edema. However, there is no direct and effective data to prove that it can reduce mortality.

Key words： Septic shock Fluid resuscitation Central venous oxygen saturation(ScvO2);Central venous-arterial blood carbon dioxide partial pressure difference［P(cv-a)CO2］ Disease outcome Mechanical ventilation time Incidence of pulmonary edema

About author:: Niu Xing-guo, E-mail：kmepngc@163.com

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	Niu Xing-guo
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	Wang Xiao-wen
	Li Jin-xiu
	Wang Hong-yu

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Niu Xing-guo,Zhang Si-sen,Jiao Xian-fa, et al. Meaning and effect of ScvO2 combined with P(cv-a)CO2 on fluid resuscitation in the patients with septic shock[J]. Chinese Journal of Critical Care Medicine, 2019, 39(10): 939-944.

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http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2019.10.004 OR http://www.cnemergency.org.cn/EN/Y2019/V39/I10/939

［1］吴新军，何立东，孙小勇. 感染性休克患者临床流行病学分析［J］. 中华医院感染学杂志， 2014， 24(6): 1378-1380. ［2］郑辉才，杨进军. 内科ICU感染性休克预后死亡危险因素流行病学调查分析［J］. 医学综述， 2015， 21(15): 2859-2861. ［3］尹文，李俊杰. 感染性休克发病机制的研究进展［J］. 中国急救医学， 2015， 35(3): 196-202. ［4］Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016［J］. Crit Care Med, 2017, 45(3): 486-552. ［5］王振贤，胡少敏，陈钰，等. ScvO2和乳酸清除率指导严重感染患者早期液体复苏的效果比较［J］. 海南医学， 2015， 26(15): 2215-2217. ［6］Lee S, Hong Y, Park J, et al. Initial high ScvO2, is related to organ dysfunction in severe sepsis and septic shock patients［J］. J Emerg Med, 2012, 43(5):917.  ［7］吕晓春，许强宏，蔡国龙，等. ScvO2联合乳酸清除率指导脓毒症休克患者的容量复苏［J］. 中华医学杂志，2015，95(7):496-500. ［8］邱光钰，刘阳. 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指导感染性休克液体复苏［J］. 内科急危重症杂志， 2016， 22(5): 369-370. ［9］刘亚林，张雪飞，赵中林，等. P(cv-a)CO2评价创伤性休克患者液体复苏效果的价值［J］.海南医学， 2015， 26(10): 1441-1443. ［10］He H, Long Y, Liu D, et al. The prognostic value of central venous-to-arterial CO2 difference/arterial-central venous O2 difference ratio in septic shock patients with central venous O2 saturation ≥80［J］. Shock, 2017, 48(5): 551-557. ［11］Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference［J］. Crit Care Med, 2003, 31(4): 1250-1256. ［12］吴彩军，刘朝霞，刘禹赓，等. 2008年拯救严重脓毒症与感染性休克治疗指南［C］//301呼吸危重症高峰论坛, 2009. ［13］Alizadeh AM, Hassanian-Moghaddam H, Shadnia S, et al. Simplified acute physiology score II/acute physiology and chronic health evaluation II and prediction of the mortality and later development of complications in poisoned patients admitted to intensive care unit［J］. Basic Clin Pharmacol Toxicol, 2014, 115(3): 297-300.［14］Adamzik M, Langemeier T, Frey UH, et al. Comparison of thrombelastometry with simplified acute physiology score II and sequential organ failure assessment scores for the prediction of 30-day survival: a cohort study［J］. Shock, 2011, 35(4): 339-342. ［15］Quenot JP, Binquet C, Kara F, et al. The epidemiology of septic shock in French intensive care units: the prospective multicenter cohort EPISS study［J］. Crit Care, 2013, 17(2): R65. ［16］Breuling T, Tschiedel E, GroBe-Lordemann A, et al. Septic shock in children in an urban area in western germany-outcome, risk factors for mortality and infection epidemiology［J］. Klin Padiatr, 2015, 227(2): 61-65. ［17］李俊杰，尹文. 感染性休克临床治疗的研究进展［J］. 中国急救医学， 2015， 35(4): 289-296. ［18］连晓芳，阎书彩. 氧代谢指标在感染性休克中的应用进展［J］. 临床误诊误治， 2015， 28(9): 110-113. ［19］王滨，张建洁，路桂杰，等. 中心静脉-动脉二氧化碳分压差在感染性休克液体复苏策略中的指导作用［J］. 河北医药， 2016， 38(14): 2164-2166. ［20］Xu JY, Chen QH, Liu SQ, et al. The effect of early goal-directed therapy on outcome in adult severe sepsis and septic shock patients: a meta-analysis of randomised clinical trials［J］. Anesth Analg, 2016, 123(2): 371-381. ［21］余国宝，袁宁，刘毅，等. 中心静脉-动脉血二氧化碳分压差对感染性休克液体复苏指导作用的研究［J］. 重庆医学， 2013， 42(7): 729-731. ［22］辛恺. ScvO2、P(cv-a)CO2联合监测指导感染性休克患者液体复苏效果评估［J］. 锦州医科大学学报， 2017， 38(6): 67-70. ［23］侯任昉，唐勇，夏雅莉. ScvO2联合P（cv-a）CO2指导感染性休克液体复苏的临床效果研究［J］. 临床和实验医学杂志， 2017， 16(14): 1382-1385. ［24］王浩，张胜利，包章平. 静动脉血二氧化碳分压差对感染性休克患者液体复苏的指导意义［J］. 中国临床研究， 2016， 29(9): 1178-1181. ［25］连晓芳，阎书彩，王贵法，等. 静动脉二氧化碳分压差联合中心静脉血氧饱和度检测在脓毒性休克患者液体复苏中的指导作用［J］. 解放军医药杂志， 2015， 27(9): 86-90. ［26］吉春玲，杨秀林，周厚荣，等. 血浆胶体渗透压指导下的早期目标导向治疗在感染性休克患者中的应用价值［J］. 中国急救医学， 2017， 37(1): 28-32. ［27］吴超，顾勤，虞竹溪. 中心静脉-动脉二氧化碳分压差在反映感染性休克患者组织灌注及氧代谢状态的临床研究［J］. 临床急诊杂志， 2016， 17(5): 353-357. ［28］王媛媛. ScvO2与P(cv-a)CO2对外科感染性休克液体复苏的临床研究［D］. 昆明医科大学， 2013. ［29］王剑彬,王华,陈启康,等.中心静脉压、全心舒张末期容积指数和血管外肺水指数在评估脓毒性休克液体复苏中的作用［J］.南方医科大学学报, 2014, 34(9):1334-1336. ［30］刘亚林,邹帅,赵中林,等.PiCCO监测技术在感染性休克患者液体复苏及血管活性药物应用中的指导作用［J］.中华医院感染学杂志, 2016, 26(10):2254-2256.