ICU脓毒症患者容量管理中静动脉二氧化碳分压差指导的有效性分析

ICU脓毒症患者容量管理中静动脉二氧化碳分压差指导的有

效性分析

[摘要]目的探讨ICU脓毒症患者容量管理中静动脉二氧化碳分压差指导的有效性。方法将本院于2018年3月～2019年3月收治的40例ICU脓毒症患者作为研究对象，随机分为两组，均在液体复苏期间进行常规检测，A组在常规检测基础上增加血乳酸指导、B组在常规检测基础上增加动脉二氧化碳分压差指导。患者入住ICU及时给予液体复苏治疗，记录各组患者的结局。结果两组患者复苏0 h时的各项指标与复苏6 h时的各项指标水平比较，差异有统计学意义（P<0.05）;两组患者复苏6 h时的HR、CVP、Lac、Pcv-aCO2、ScvO2水平比较，差异有统计学意义（P<0.05）;B组患者的机械通气时间、住院时间短于A组患者（P<0.05）。B组患者的治疗1周死亡率与治疗4周死亡率均低于A组（P<0.05）;死亡患者与存活患者的APACHEⅡ评分、Lac清除率、Lac 水平、ScvO2水平比较，差异有统计学意义（P<0.05）。结论在ICU脓毒症患者容量管理中应用静动脉二氧化碳分压差指导，效果有统计学意义，可有效改善患者预后，提高患者的生存率。

[关键词] ICU;脓毒症;容量管理;血乳酸;静动脉二氧化碳分压差;液体复苏

[Abstract] Objective To explore and analyze the effectiveness of the guidance of venous carbon dioxide partial pressure difference in volume management of ICU sepsis patients. Methods Forty cases of ICU sepsis patients admitted to our hospital from March 2018 to March 2019 were taken as the research object. The patients were randomly divided into

two groups and were routinely tested during fluid resuscitation. The group A increased blood lactate guidance based on routine testing. The group B increased arterial carbon dioxide partial pressure difference guidance based on routine testing. The patients were given fluid resuscitation treatment in time on admission to the ICU. The outcome of patients in each group was recorded. Results There were significant differences in the level of various indicators at 0 h and 6 h of recovery between the two groups（P<0.05）. There were significant differences in the levels of HR，CVP，Lac，Pcv-aCO2 and ScvO2 between the two groups at 6 h of recovery（P<0.05）. The mechanical ventilation time and hospital stay of patients in group B were shorter than those in group A （P<0.05）. The one-week mortality and the four-week mortality of group B were lower than those of group A（P<0.05）. APACHEⅡscore，Lac clearance rate，Lac level and ScvO2 level of dead patients and surviving patients were significantly differences（P<0.05）. Conclusion The guidance of venous artery carbon dioxide partial pressure difference in volume management of patients with sepsis in ICU has a significant effect，which can effectively improve the prognosis of patients and improve the survival rate of patients.

[Key words] ICU; Sepsis; Volume management; Blood lactic acid; Venous artery carbon dioxide partial pressure difference; Fluid resuscitation

脓毒症是常见危急重症，主要死亡原因是重度脓毒症、脓毒症休克。而液体复苏是治疗ICU脓毒症的基础、有效措施，也是我国急危重症领域研究的重点与热点。但也有研究指出，ICU脓毒症应用液体复苏治疗时易发生血容量不足、血容量过多等不良症状，这些不良症状会导致患者的器官功能受损。因此，在治疗ICU脓毒症期间，为保证临床治疗效果，减少医源性损害的发生，临床常在容量管理中应用评估指导。近年来，有研究学者[1]提出，在ICU脓毒症患者容量管理中添加血乳酸指导，可进一步提高容量效果。也有研究[2]指出，在ICU 脓毒症患者容量管理中添加静动脉二氧化碳分压差指导效果更佳。本文旨在探究分析ICU脓毒症患者容量管理中静动脉二氧化碳分压差指导的有效性，現报道如下。

1 资料与方法

1.1 临床资料

将本院于2018年3月～2019年3月收治的40例ICU脓毒症患者作为研究对象，随机分为两组，每组20例。40例患者中男24例，女16例，年龄48～80岁，平均（604.24±6.11）岁;感染源：腹腔14例，肺部17例，其他9例;APACHE Ⅱ评分（18.5±4.0）分。其中A组的男女比是13∶7;年龄49～79（64.17±6.24）岁;腹腔感染7例，肺部感染9例，其他感染4例;APACHEⅡ评分（18.4±4.0）分。B组的男女比是11∶9;年龄48～80（64.68±6.08）岁;腹腔感染7例，肺部感染8例，其他感染5例;APACHEⅡ评分（18.6±3.9）分。两组脓毒症患者的基础资料比较，差异无统计学意义（P>0.05）。见表1。

纳入标准：年龄18岁以上;最少满足全身炎症反应综合征的诊断标准中的2项标准，体温≥38℃，呼吸>20次/min，心率>90次/min，二氧化碳分压<32