摘要
目的 探讨以血清降钙素原(PCT)与乳酸清除率指导脓毒性休克(septic shock,SS)患者早期液体复苏治疗的临床价值。方法 方便选取甘肃医学院附属医院2019年6月—2021年6月诊治的72例SS患者为研究对象,按随机数表法分为两组,各36例。对照组以中心静脉血氧饱和度(ScvO_(2))为指导施以早期液体复苏治疗,观察组则以血清PCT和乳酸清除率为指导施行早期液体复苏治疗。对比两组临床相关指标、生命体征、病情严重程度。结果 两组72 h输液量、72 h晶体量、72 h胶体量、入住重症监护病房(ICU)时间与28 d病死率相比,差异无统计学意义(P>0.05)。复苏前、复苏72 h后,两组心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、ScvO_(2)相比,差异无统计学意义(P>0.05)。复苏前,两组急性生理学和慢性健康状况评价Ⅱ(APACHE-Ⅱ)评分相比,差异无统计学意义(P>0.05);复苏72 h后,观察组APACHE-Ⅱ评分为(18.44±2.69)分低于对照组的(21.45±3.25)分,差异有统计学意义(t=4.281,P<0.001)。结论 以血清PCT与乳酸清除率指导SS患者施行早期液体复苏治疗作用明显,可取得与以ScvO_(2)为指导进行治疗的相同作用,有利于稳定患者的生命体征,有效控制病情。
Objective To investigate the clinical value of using serum procalcitonin(PCT)and lactate clearance rate to guide early fluid resuscitation therapy in patients with septic shock(SS).Methods A total of 72 SS patients diagnosed and treated in the Affiliated Hospital of Gansu Medical College from June 2019 to June 2021 were conveniently selected as the research objects,and divided into two groups according to random number table method,with 36 cases in each group.The control group was guided by central venous oxygen saturation(ScvO_(2)),and the observation group was guided by serum PCT and lactate clearance.Clinical indicators,vital signs and severity of disease were compared between the two groups.Results There was no statistically significant difference between the two groups in 72 h infusion volume,72 h crystal volume,72 h colloid volume,time of hospitalization in ICU and 28 d mortality(P>0.05).Before and 72 h after resuscitation,there was no statistically significant difference in heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP)and ScvO_(2) between the two groups(P>0.05).Before resuscitation,there was no statistically significant difference in acute physiology and chronic health status evaluationⅡ(APACHE-Ⅱ)scores between the two groups(P>0.05);after 72 h of resuscitation,the APACHE-Ⅱscore of the observation group(18.44±2.69)points was lower than that of the control group(21.45±3.25)points,and the difference was statistically significant(t=4.281,P<0.001).Conclusion The guidance of serum PCT and lactate clearance for early fluid resuscitation in SS patients has obvious effect,and can achieve the same effect as the guidance of ScvO_(2) therapy,which is conducive to the stability of patients'vital signs and effective control of the disease.
作者
马亮
MA Liang(Department of Critical Care Medicine,Affiliated Hospital of Gansu Medical College,Pingliang,Gansu Province,744000 China)
出处
《中外医疗》
2023年第6期9-13,共5页
China & Foreign Medical Treatment
