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目的研究应用中心静脉血氧饱和度(ScvO2)和血乳酸清除率指导严重感染病人液体复苏的意义。方法将2006年1月至2006年12月中国医科大学附属第一医院重症医学科收治的74例严重感染及感染性休克病人随机分组,分别以容量复苏成功(A组),容量复苏成功且ScvO2>70%(B组),容量复苏成功且乳酸清除率达10%(C组)为目标。确诊后经验性给予抗生素治疗的同时积极进行液体复苏达标后维持72h。结果B组和C组发生多器官功能障碍综合征(MODS)的比例分别为33.3%和28.6%,均低于A组(54.5%),其中C组与A组比较有统计学意义(P=0.043)。A组和B组7d病死率(27.3%,20.8%)接近且均高于C组(3.6%),A组与C组比较有统计学意义(P=0.021)。从生存分析曲线来看B、C两组病死率均低于A组。B组和C组病人住ICU时间分别为(6.53±12.10)d和(6.95±13.52)d均短于A组(8.465±11.97)d,P<0.05。结论应用ScvO2及血乳酸清除率指导严重感染的液体复苏可以降低严重感染和感染性休克病人MODS的发生率及病死率。
Objective To study the significance of using central venous oxygen saturation (ScvO2) and blood lactic acid clearance to guide liquid resuscitation in severely infected patients. Methods Seventy-four patients with severe septic shock and septic shock admitted to the First Affiliated Hospital of China Medical University from January 2006 to December 2006 were randomly divided into two groups: group A (volume A), volume resuscitation (group B) and ScvO2 > 70% (group B), successful volume resuscitation and lactic acid clearance of 10% (group C). After the diagnosis of experiencing antibiotic therapy, the positive rate of liquid resuscitation was maintained for 72 hours after reaching the standard. Results The incidence of multiple organ dysfunction syndrome (MODS) in group B and C were 33.3% and 28.6%, respectively, which were lower than those in group A (54.5%). There was a significant difference between group C and group A (P = 0.043). The mortality rates of group A and group B at 7 days (27.3%, 20.8%) were close to those of group C (3.6%). There was a significant difference between group A and group C (P = 0.021). From the survival analysis of curve point of view, B, C two groups were lower than the mortality of A group. The ICU time of patients in group B and group C were (6.53 ± 12.10) d and (6.95 ± 13.52) d respectively, shorter than that in group A (8.465 ± 11.97) d, P <0.05. Conclusion The application of ScvO2 and blood lactic acid clearance to guide the severe infection of liquid resuscitation can reduce the incidence of severe morbidity and septic shock in patients with MODS and mortality.