乳酸清除率联合静动脉血二氧化碳分压差对感染性休克患者预后的评估

doi:10.3969/j.issn.1002-1949.2017.10.010

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摘要目的：探讨乳酸清除率联合静动脉血二氧化碳分压差在预测感染性休克患者预后中的临床价值。方法：收集2014-01～2016-06兰州大学第二医院内科ICU收治的103例感染性休克患者的临床资料。根据2012年《严重脓毒症和脓毒症休克指南》要求进行复苏，患者均分别于复苏前(0h)、复苏后6h测定桡动脉和颈内静脉血行血气分析，测定动脉血乳酸(Lac)、中心静脉二氧化碳分压(PcvCO 2)、动脉血二氧化碳分压(PaCO2)，计算乳酸清除率(LCR)、静脉-动脉血二氧化碳分压差Pcv-aCO2(ΔPCO2)。纳入研究的患者根据入院后28 ｄ的结局分为存活组和死亡组，比较两组患者Lac、ScvO2、6h LCR及ΔPCO2。根据液体复苏后6h LCR及ΔPCO2分为四组：A组 LCR＜10%、ΔPCO2≥6 mm Hg；B组 LCR≥10%、ΔPCO2≥6 mm Hg；C 组LCR＜10%、ΔPCO2＜6 mm Hg；D 组LCR≥10%、ΔPCO2＜6 mm Hg。比较组间患者ICU住院时间及28 d病死率。结果：与死亡组患者比较，存活组患者复苏6h LCR显著增大，ΔPCO2显著减少，差异有统计学意义；6h LCR及ΔPCO2分为四组的患者组间比较显示，D组患者28 d病死率最低，A组患者28d病死率最高，ICU住院时间组间无统计学意义。结论： ΔPCO2联合6 h LCR在预测脓毒症患者预后中具有良好的临床应用价值。

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收稿日期: 2017-05-05

基金资助:甘肃省自然科学基金（145RJZA105）；甘肃省卫生行业科研计划项目（GSWSKY-2015-66）

作者简介: 曹雯(1970-)，女，主任医师，E-mail: smilecao2009@sina.com

引用本文:

曹雯，高雪花，李培杰，罗延年，王雪婷，连佛颜，何囡囡，关银. 乳酸清除率联合静动脉血二氧化碳分压差对感染性休克患者预后的评估[J]. 中国急救医学, 2017, 37(10): 916-919.
Cao Wen, Gao Xue-hua, Li Pei-jie, Luo Yan-nian, Wang Xue-ting, Lian Fo-yan, He Nan-nan, Guan Yin. The lactate clearance rate combined with venoarterial carbon dioxide difference to evaluate the prognosis of patients with septic shock. Chinese Journal of Critical Care Medicine, 2017, 37(10): 916-919.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2017.10.010 或 http://www.cnemergency.org.cn/CN/Y2017/V37/I10/916

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