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目的:探讨P(cv-a)CO_2/C(a-v)O_2变化与P(cv-a)CO_2变化在重症脓毒症及脓毒性休克患者液体复苏中的临床价值,并比较二者与乳酸清除率的相关性。方法:入选上海仁济医院急诊监护室收治的合并高乳酸血症(≥4 mmol/L)的重症脓毒症或脓毒症休克患者60例,按脓毒症指南早期目标导向治疗(EGDT)进行复苏,检测复苏前(0 h)和复苏后(6 h)、(24 h)的动脉血、上腔静脉血气以及乳酸浓度,分别计算各时间点的P(cv-a)CO_2/C(a-cv)O_2值,P(cv-a)CO_2值,分析比较与各时间点血乳酸水平的相关性。分别计算复苏前后的P(cv-a)CO_2/C(a-cv)O_2值和P(cv-a)CO_2值的变化值,比较与相应时间点乳酸清除率的相关性。结果:复苏前和复苏后的P(cv-a)CO_2/C(a-cv)O_2值以及P(cv-a)CO_2值与血乳酸浓度明显相关,r分别为0.873,0.644(0 h);0.885,0.585(6h);0.858,0.669(24 h),(P均<0.01),且前者相关性优于后者。复苏前后的P(cv-a)CO_2/C(a-cv)O_2值的变化和P(cv-a)CO_2值的变化都与相应时间点的乳酸清除率明显相关,r分别为0.874,0.635(6h);0.807,0.530(24h);并且前者的相关性优于后者(均P<0.05)。结论:P(cv-a)CO_2/C(a-cv)O_2比P(cv-a)CO_2能更好的提示液体复苏过程中组织缺氧情况的变化。
Objective: To investigate the clinical value of changes in P (cv-a) CO 2 / C (av) O 2 and changes in P (cv-a) CO 2 in patients with severe sepsis and septic shock and to compare their efficacy with lactate clearance Rate of relevance. Methods: Sixty patients with severe sepsis or septic shock who were admitted to the emergency room of Renji Hospital of Shanghai with sepsis (≥4 mmol / L) were enrolled in this study. According to sepsis guidelines for early target-oriented therapy (EGDT) The levels of P (cv-a) CO 2 / C (P <0.05) were calculated at each time point after arterial blood and superior vena cava blood gas and lactic acid concentrations before resuscitation (0 h), after resuscitation (6 h) a-cv) O_2 values and P (cv-a) CO_2 values were analyzed and compared with the levels of blood lactic acid at each time point. The changes of P (cv-a) CO 2 / C (a-cv) O 2 and P (cv-a) CO 2 before and after resuscitation were calculated and compared with the corresponding time lactic acid clearance. RESULTS: The values of P (cv-a) CO 2 / C (a-cv) O 2 and P (cv-a) CO 2 were positively correlated with the blood lactate concentrations before and after resuscitation, with r values of 0.873 and 0.644 (0 h) ; 0.885,0.585 (6h); 0.858,0.669 (24 h), (P <0.01), and the former was better than the latter. The change of P (cv-a) CO 2 / C (a-cv) O 2 and the change of P (cv-a) CO 2 before and after resuscitation were all significantly correlated with the lactic acid clearance at corresponding time points (6h); 0.807,0.530 (24h); and the former was better than the latter (all P <0.05). CONCLUSION: P (cv-a) CO 2 / C (a-cv) O 2 is better than P (cv-a) CO 2 in predicting the changes of tissue hypoxia during fluid resuscitation.