关键词:

脓毒症, 脓毒症休克, 静?动脉二氧化碳分压差, 乳酸清除率, 容量监测, 液体复苏

Abstract:

Objective This study investigated the prognostic significance of Pcv ⁃aCO2 combined with lactate clearance rate（LCR）as goals of early sepsis resuscitation. Methods From August 2017 to December 2018，68 patients who were diagnosed as sepsis and need for fluid resuscitation in ICU in Binzhou Medical University Hospital were recruited. When patients were admitted to hospital，they were immediately given fluid resuscitation as early as possible. The arterial and central venous blood gases were measured simultaneously at 0 hours（T0）and 6 hours（T6）after resuscitations and calculated the Pcv⁃aCO2 and LCR. Patients were classified into four groups according to Pcv⁃aCO2 and LCR at 6 h after fluid resuscitation：group A（Pcv⁃aCO2 > 6 mmHg and LCR < 30%）， group B（Pcv⁃aCO2 > 6 mmHg and LCR ≥ 30%），group C（Pcv⁃aCO2 ≤ 6 mmHg and LCR < 30%），group D（Pcv⁃ aCO2 ≤ 6 mmHg and LCR ≥ 30%）. General demographics，physiological indicators，laboratory parameters，the volume of fluid entering and the prognosis were compared among the four groups. Results The general clinical data of patients between the four groups before fluid resuscitation treatment，such as acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）score and sequential organ failure assessment（SOFA）score on the first day after admission to the ICU，and source of the primary infection site，was not significantly different（P > 0.05）. At T0 and T6，Pcv⁃aCO2 had correlation with ScvO2. At T6，Pcv⁃aCO2 had correlation with LCR. Conclusions Pcv⁃aCO2 has a good correlation with ScvO2 and lactate clearance rate，the combination of Pcv⁃aCO2 and LCR can assess the condition of septic shock patients，and avoid inadequate fluid resuscitation when the Scv02 goal was false⁃normaliza⁃ tion，which can be used as the goal of fluid resuscitation in patients with severe sepsis or septic shock. 

Key words:

sepsis, septic shock, central venous?to?arterial carbon dioxide difference, lactate clear? ance rate, volume monitoring, fluid resuscitation