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| The application value of early goal directed therapy under the guidance of plasma colloid osmotic pressure in patients with septic shock |
| JI Chun-Ling, YANG Xiu-Lin, ZHOU Hou-Rong, HUANG Xiao-Mo, LIU Xiu-Juan, QU Xiang, ZHANG Qian |
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Abstract Objective To investigate the clinical effect of early goal directed therapy（EGDT）guided by plasma colloid osmotic pressure in patients with septic shock. Methods Forty cases of patients with septic shock were selected from March 2014 to February 2016 in the emergency department of Guizhou People's Hospital, the patients were divided into EGDT group（20 cases）and plasma colloid os⁃motic pressure（PCOP）group（20 cases）according to the random number table method. The EGDT group was given routine septic shock bundle treatment program for fluid resuscitation, the blood sam⁃pling was selected to monitor PCOP value in PCOP group in addition to conventional EGDT treatment, and according to the PCOP value to guide the fluid recovery, always stabling the PCOP values in the normal ranges（19～25 mm Hg）. The following indicators were detected in two groups in the diagnosis of infection shock 0, 6, 24, 72 h time point including acute physiology science and chronic health evaluationⅡ（APACHEⅡ）score, and number of application cases of vasoactive drugs, the oxygen index（PaO2/FiO2）, serum procalcitionin（PCT）level, central venous pressure（CVP）, mean arterial pressure（MAP）,
blood lactic acid, and calculating the time of mechanical ventilation and living intensive care unit（ICU）time as well as 14 days fatality rate. Results The APACHEⅡ score and the number of application cases of vasoactive drugs were decreased gradually comparing with before treatment, the above indicates in the PCOP group were significantly lower than that of traditional liquid group in the treatment 72 h［APACHEⅡ score（sub）:（13.2±6.3）vs. （17.21±6.5）, use of vasoactive drugs cases: 4 vs. 9, P＜0.05］. After treatment, the oxygenation index of the two groups increased, the PCOP group was significantly higher than that of the traditional EGDT group in the treatment 72 h［PaO2/FiO2:（157.5±21.2）mm Hg vs.（112±20.2）mm Hg］. The PCT levels were gradually decreased after treatment and significantly lower than those before treatment at the 72 h hours point（all P＜0.05）, but there was no significant difference between the two groups at each time point. The lactate clearance rate increased gradually in two groups,but the lactic acid clearance rate in the PCOP group at each time point were significantly higher than those of conventional liquid resuscitation group［6 h:（18.7±8.1）% vs.（15.4±7.1）%, t＝-6.033, P＝0.001; 24 h:（21.3±7.3）% vs.（11.4±7.1）%, t＝-4.516, P＝0.001; 48 h:（28.6±5.9）% vs.（19.2±9.4）%, t＝-6.836, P＝0.001］. The volume of fluid resuscitation of PCOP group within 6 hours were significantly higher than that of EGDT group［（3912±892）mL vs.（2796±795）mL, t＝-3.781, P＝
0.031）; the volume of fluid resuscitation after the 24 h and 72 h were decreased significantly comparing with the traditional cluster group; it was the lowest after the 72 h［（1023±452）mL vs.（1845±420）mL, t＝5.908, P＝0.033）. The mechanical ventilation time and the length of ICU stay were significantly
shorter than the traditional EGDT, the mechanical ventilation time［（93.4±21.3）h vs.（12.53±29.6）h,t＝9.753, P＝0.001］, length of ICU stay［（7.3±2.9）d vs.（9.8±3.6）d, t＝2.993, P＝0.004）, but 14 days fatality rate was slightly lower than that of traditional EGDT［27.27%（6/22）than 33.33%（7/21）,
t＝0.433, P＝0.752］. Conclusion The early goal-directed therapy guided by the plasma colloid osmotic pressure can reduce the severity of the patients with septic shock, guide fluid resuscitation more accurately and reduce lung water to improve oxygenation, and shorten the time of mechanical ventilation
and ICU stay, so it has great clinical significance.
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