血管外肺水联合中心静脉-动脉二氧化碳分压差在脓毒性休克早期目标导向性治疗中的应用研究

Application of extravascular lung water combined with central venous-arterial carbon dioxide difference in early goal-directed therapy for septic shock

摘要:

目的：探讨动态监测血管外肺水（extravascular lung water，EVLW）联合中心静脉-动脉二氧化碳分压差（central venous-arterial difference of CO2 partial pressure，P（cv-a）CO2）在脓毒性休克早期目标导向性治疗中的意义。方法：选择2015至2018年重庆医科大学附属二院和重庆市中医院ICU入住的脓毒性休克患者80例，采用随机分组的原则将患者分为早期目标导向治疗组（EGDT组）和EVLW联合P（cv-a）CO2目标导向组（EP组）。EGDT组按照常规方案进行液体复苏，EP组在脉搏指数连续心排量监测技术（pulse-induced contour cardiac output，PiCCO）监测下行液体复苏。比较2组复苏6 h达标率、复苏液体量、去甲肾上腺素用量、每小时公斤体质量尿量、乳酸清除率、P（cv-a）CO2、EVLW及28 d病死率。结果：EP组每小时公斤体质量尿量和乳酸清除率均明显高于EGDT组（P＜0.05）；复苏6 h液体量、CVP、血管活性药物用量、P（cv-a）CO2、EVLW和28 d病死率均明显低于EGDT组（P＜0.05）；2组间复苏6 h达标率、MAP、ScvO2无统计学差异（P>0.05）。结论：EVLE联合P（cv-a）CO2指导脓毒性休克早期目标导向性治疗，能尽早且更准确地判断脓毒性休克患者的组织灌注状态和容量负荷状态，指导合理的液体复苏治疗，降低患者病死率。

Abstract:

Objective：To investigate the value of dynamic monitoring of extravascular lung water（EVLW） combined with central venous-arterial difference of CO2 partial pressure（P（cv-a）CO2） in early goal-directed therapy（EGDT） for septic shock. Methods：Eighty patients with septic shock，who were admitted to the Intensive Care Unit of the Second Affiliated Hospital of Chongqing Medical Uni－versity and Chongqing Hospital of Traditional Chinese Medicine from 2015 to 2018，were enrolled and randomly divided into EGDT group and EVLW+ P（cv-a）CO2（EP） group. The patients in the EGDT group underwent conventional fluid resuscitation，and those in the EP group underwent fluid resuscitation under monitoring with pulse-induced contour cardiac output. The two groups were compared in terms of the rate of achieving EGDT target after 6-h resuscitation，resuscitation fluid volume，the dose of noradrenaline，urine volume/kg body weight/hour，lactic acid clearance rate，P（cv-a）CO2，EVLW，and 28-day mortality. Results：Compared with the EGDT group，the EP group had significantly higher urine volume/kg body weight/hour and lactic acid clearance rate（P<0.05） and significantly lower 6-h resuscitation fluid volume，central venous pressure，dose of vasoactive agent，P（cv-a）CO2，EVLW，and 28-day mortality（P<0.05）. There were no significant differences in the rate of achieving EGDT target after 6-h resuscitation，mean arterial pressure，and central venous oxygen saturation between the two groups（P>0.05）. Conclusion：In EGDT for septic shock，EVLW combined with P（cv-a）CO2 can help assess the tissue perfusion and volume loading of pa－tients early and accurately，thus guiding fluid resuscitation and reducing the mortality of patients.