摘要
目的：研究感染性休克患者血流动力学和氧合功能的变化。方法：因输液致感染性休克患者８ 例，入ＩＣＵ后置入Ｓｗａｎ Ｇａｎｚ导管测定中心静脉压（ＣＶＰ）、肺动脉平均压（ＭＰＡＰ）、肺毛细血管嵌压（ＰＣＷＰ）；用热稀释法测定心排血量（ＣＯ），同时监测平均动脉压（ＭＡＰ）和心率。于入ＩＣＵ 后１、２、３、４ 和５ 日内进行血气分析，计算出氧输送（ＤＯ２ ）、氧耗量（ＶＯ２ ）、氧摄取率（Ｏ２ｅｘｔｒ）、肺内分流率（Ｑｓ／Ｑｔ）、肺泡 动脉血氧分压差〔Ｐ（Ａ－ ａ）Ｏ２ 〕、外周血管阻力指数（ＳＶＲＩ）、肺血管阻力指数（ＰＶＲＩ）和心排指数（ＣＩ）。结果：感染性休克患者入ＩＣＵ 后１ 日内ＭＡＰ和ＣＶＰ分别降低３８．５％ 和４２．８％ （Ｐ均＜ ０．０１）；入ＩＣＵ 后３ 日内ＰａＯ２ 降低３０．６％ ～４３．２％ ，〔Ｐ（Ａ－ ａ） Ｏ２ 〕和Ｏ２ｅｘｔｒ分别升高３８．８％ ～５０．３％ 和８．０％ ～３２．０％ （Ｐ均＜ ０．０１）；入ＩＣＵ 后５ 日内ＣＩ、ＰＶＲＩ、ＭＰＡＰ、ＤＯ２ 、ＶＯ２ 和Ｑｓ／Ｑｔ分别升高１２．０％ ～２２．３％ 、３５．３％ ～５８．２％ 、１７．２％ ～２４．８％ 、１１．９％ ～２０．９％ 、１４．９％
Objective:To investigate the changes in hemodynamics and oxygenation in patients with septic shock.Methods:8 patients with septic shock due to fluid infusion were included in this study.SwanGanz catheters were inserted and central venous pressure (CVP),mean pulmonary arterial pressure (MPAP),pulmonary capillary wedge pressure (PCWP),mean arterial pressure (MAP) and heart rate (HR) were measured from 1 to 5 days after the admission to the ICU.Meanwhile,blood gas analysis was made and O 2 delivery (O 2),O 2 consumption (O 2),O 2 extraction (O 2extr),intrapulmonary shunt fraction (s/t),alveolars/t),alveolart),alveolararterial oxygen difference 〔P (A-a) O 2〕,systemic vascular resistance index (SVRI),pulmonary vascular resistance index (PVRI),cardiac index (CI) were calculated.Results:MAP and CVP decreased by 38 5% and 42 8%,respectively in patients with septic shock within 1 day after the admission to the ICU (both P <0 01).PaO 2 decreased by 30 6%43 2%,P (A-a) O 2 and O 2extr respectively increased by 38 8%50 3% and 8 0%32 0% within 3 days (all P <0 01).CI,PVRI,MPAP,O 2,O 2,s/t respectively increased by 12 0%22 3%、35 3%58 2%、17 2%24 8%、11 9%20 9%、14 9%45 8% and 35 9%50 6%,while SVRI decreased by 11 3%55 1%(all P <0 01),and PCWP showed no marked changes within 5 days( P >0 05).Conclusions:In patients with septic shock,hemodynamics and oxygenation are characterized by high CI and PVRI with rather low SVRI and hypoxemia within 5 days after the admission to the ICU. s/t respectively increased by 12 0%22 3%、35 3%58 2%、17 2%24 8%、11 9%20 9%、14 9%45 8% and 35 9%50 6%,while SVRI decreased by 11 3%55 1%(all P <0 01),and PCWP showed no marked changes within 5 days( P >0 05).Conclusions:In patients with septic shock,hemodynamics and oxygenation are characterized by high CI and PVRI with rather low SVRI and hypoxemia within 5 days after the admission to the ICU. t respectively increased by 12 0%22 3%、35 3%58 2%、17 2%24 8%、11 9%20 9%、14 9%45 8% and 35 9%50 6%,while SVRI decreased by 11 3%55 1%(all P <0 01),and PCWP showed no marked changes within 5 days( P >0 05).Conclusions:In patients with septic shock,hemodynamics and oxygenation are characterized by high CI and PVRI with rather low SVRI and hypoxemia within 5 days after the admission to the ICU.
出处
《中国危重病急救医学》
CAS
CSCD
1999年第12期739-741,共3页
Chinese Critical Care Medicine
