论文部分内容阅读
目的观察和比较血乳酸清除率与中心静脉血氧饱和度(centra venous blood oxygen satuation,S_(rv)O_2)在感染性休克治疗评估中的作用。方法入选感染性休克患者90例,随机分为常规液体复苏组(常规组,n=30)、血乳酸清除率组(乳酸组n=30)和S_(cv)O_2组(n=30)。常规组经验给予抗生素治疗的同时积极进行液体复苏,容量复苏成功后维持治疗72 h;乳酸组在容量复苏成功后如果乳酸清除率未达到10%,则在滴定式调整容量的同时应用血管活性药,乳酸清除率达10%后维持治疗72h;S_(cv)O_2组在容量复苏成功后如果S_(cv)O_2低于70%,则在滴定式调整容量的同时应用血管活性药,S_(cv)O_2>70%后维持治疗72h。比较各组间的多脏器功能障碍综合征(multiple organ dysfunction syndrome,MODS)发生率、7d与28d病死率、重症监护病房(intensive care unit,ICU)住院时间、总住院时间的差异。结果乳酸组和S_(cv)O_2组的MODS发生率、7d与28d病死率、ICU住院时间、总住院时间均低于常规组(P<0.05),但乳酸组与S_(cv)O_2组之间差异无统计学意义(P>0.05)。结论血乳酸清除率和中心静脉血氧饱和度用于指导感染性休克的液体复苏,可以降低患者MODS的发生率及病死率,减少住院时间,但二者的作用近似。
Objective To observe and compare the effect of serum lactate clearance and centra venous blood oxygen saturation (S rv O 2) in the evaluation of septic shock treatment. Methods Totally 90 septic shock patients were randomly divided into routine liquid resuscitation group (n = 30), blood lactic acid clearance group (n = 30) and S_ (cv) O_2 group (n = 30). Conventional group experienced active antibiotic therapy while fluid recovery, volume recovery after successful treatment for 72 h; lactic acid group in the capacity recovery success if lactic acid clearance rate of less than 10%, in the titration to adjust the capacity of the application of vasoactive drugs , And the lactic acid clearance rate was maintained at 72% after 72 hours. If S_ (cv) O_2 was less than 70% after volume resuscitation, vasoactive drugs, S_ (cv ) O_2> 70% maintenance treatment 72h. The incidences of multiple organ dysfunction syndrome (MODS), mortality at 7d and 28d, hospital stay of intensive care unit (ICU) and total hospital stay were compared between groups. Results The incidence of MODS, the mortality at 7d and 28d, the length of stay in hospital and the length of hospital stay in lactic acid group and S_ (cv) O_2 group were lower than those in conventional group (P <0.05) There was no significant difference between the two groups (P> 0.05). Conclusions Blood lactate clearance and central venous oxygen saturation are used to guide liquid resuscitation in septic shock, which can reduce the incidence of MODS and mortality in patients and reduce the hospitalization time, but their effects are similar.