目的探讨中心静动脉血二氧化碳分压差（Pcv—aCO2）和早期乳酸清除率在评估感染性休克患者预后中的临床意义。方法选取2010-01—2013—10收住我院重症医学科的82例经早期目标导向治疗（EGDT）达标的感染性休克患者进行前瞻性观察研究，...目的探讨中心静动脉血二氧化碳分压差（Pcv—aCO2）和早期乳酸清除率在评估感染性休克患者预后中的临床意义。方法选取2010-01—2013—10收住我院重症医学科的82例经早期目标导向治疗（EGDT）达标的感染性休克患者进行前瞻性观察研究，记录入院6hPcv—aCO2及患者入院后第-个24h急性生理学和慢性健康状况评分系统Ⅱ（acute physiology and chronic health evaluationⅡ，APACHEⅡ）评分和全身性感染相关性器官衰竭（SOFA）评分；并记录入院时、人院6h、入院24h动脉血乳酸，计算早期乳酸清除率；以入院6hPcv—aCO2高低分为两组：A组（Pcv—aCO2〈6mmHg）和B组（Pcv—aCO2≥6mmHg），比较两组患者乳酸清除率、SOFA评分及病死率。以6h乳酸清除率高低分为两组：c组（乳酸清除率≤10％）和D组（乳酸清除率〉10％），比较两组患者的28天病死率。根据28天病程转归分为死亡组（32例）和存活组（50例），比较两组患者不同时间动脉血乳酸浓度、APACHEⅡ评分。结果B组较A组乳酸清除率低，SOFA评分及病死率高，入院6hPcv—aCO2与6h乳酸清除率存在负相关（r=-0．324，P=0．003）。D组病死率低于C组（P〈0．05）。存活组APACHEⅡ评分较死亡组高，而入院时、6h、24h动脉血乳酸浓度均低于死亡组（P〈0．05）。结论6hPcv—aC02和6h乳酸清除率可作为判断感染性休克患者预后的指标。展开更多
Purpose:Assessing fluid responsiveness relying on central venous oxygen saturation(ScvO_(2))yields varied outcomes across several studies.This study aimed to determine the ability of the change in ScvO_(2)(ΔScvO_(2))...Purpose:Assessing fluid responsiveness relying on central venous oxygen saturation(ScvO_(2))yields varied outcomes across several studies.This study aimed to determine the ability of the change in ScvO_(2)(ΔScvO_(2))to detect fluid responsiveness in ventilated septic shock patients and potential influencing factors.Methods:In this prospective,single-center study,all patients conducted from February 2023 to January 2024 received fluid challenge.Oxygen consumption was measured by indirect calorimetry,and fluid responsiveness was defined as an increase in cardiac index(CI)≥10%measured by transthoracic echocardiography.Multivariate linear regression analysis was conducted to evaluate the impact of oxygen consumption,arterial oxygen saturation,CI,and hemoglobin on ScvO_(2)and its change before and after fluid challenge.The Shapiro-Wilk test was used for the normality of continuous data.Data comparison between fluid responders and non-responders was conducted using a two-tailed Student t-test,Mann Whitney U test,and Chi-square test.Paired t-tests were used for normally distributed data,while the Wilcoxon signed-rank test was used for skewed data,to compare data before and after fluid challenge.Results:Among 49 patients(31 men,aged(59±18)years),27 were responders.The patients had an acute physiology and chronic health evaluation II score of 24±8,a sequential organ failure assessment score of 11±4,and a blood lactate level of(3.2±3.1)mmol/L at enrollment.After the fluid challenge,theΔScvO_(2)(mmHg)in the responders was greater than that in the non-responders(4±6 vs.1±3,p=0.019).Multivariate linear regression analysis suggested that CI was the only independent influencing factor of ScvO_(2),with R2=0.063,p=0.008.After the fluid challenge,the change in CI became the only contributing factor toΔScvO_(2)(R2=0.245,p<0.001).ΔScvO_(2)had a good discriminatory ability for the responders and non-responders with a threshold of 4.4%(area under the curve=0.732,p=0.006).Conclusion:ΔScvO_(2)served as a reliable surrogate marker forΔCI and could be utilized to assess fluid responsiveness,given that the change in CI was the sole contributing factor to theΔScvO_(2).In stable hemoglobin conditions,the absolute value of ScvO_(2)could serve as a monitoring indicator for adequate oxygen delivery independent of oxygen consumption.展开更多
文摘目的探讨中心静动脉血二氧化碳分压差（Pcv—aCO2）和早期乳酸清除率在评估感染性休克患者预后中的临床意义。方法选取2010-01—2013—10收住我院重症医学科的82例经早期目标导向治疗（EGDT）达标的感染性休克患者进行前瞻性观察研究，记录入院6hPcv—aCO2及患者入院后第-个24h急性生理学和慢性健康状况评分系统Ⅱ（acute physiology and chronic health evaluationⅡ，APACHEⅡ）评分和全身性感染相关性器官衰竭（SOFA）评分；并记录入院时、人院6h、入院24h动脉血乳酸，计算早期乳酸清除率；以入院6hPcv—aCO2高低分为两组：A组（Pcv—aCO2〈6mmHg）和B组（Pcv—aCO2≥6mmHg），比较两组患者乳酸清除率、SOFA评分及病死率。以6h乳酸清除率高低分为两组：c组（乳酸清除率≤10％）和D组（乳酸清除率〉10％），比较两组患者的28天病死率。根据28天病程转归分为死亡组（32例）和存活组（50例），比较两组患者不同时间动脉血乳酸浓度、APACHEⅡ评分。结果B组较A组乳酸清除率低，SOFA评分及病死率高，入院6hPcv—aCO2与6h乳酸清除率存在负相关（r=-0．324，P=0．003）。D组病死率低于C组（P〈0．05）。存活组APACHEⅡ评分较死亡组高，而入院时、6h、24h动脉血乳酸浓度均低于死亡组（P〈0．05）。结论6hPcv—aC02和6h乳酸清除率可作为判断感染性休克患者预后的指标。
基金National Key R&D Program of China from the Ministry of Science and Technology of the People''s Republic of China(2021YFC2500801, 2022YFC2304601)CAMS Innovation Fund for Medical Sciences (CIFMS) 2021-I2M-1-062 from the Chinese Academy of Medical Sciences+1 种基金National High-Level Hospital Clinical Research Funding(2022-PUMCH-D-005, 2022-PUMCH-B111)National key clinical specialty construction projects from the National Health Commission
文摘Purpose:Assessing fluid responsiveness relying on central venous oxygen saturation(ScvO_(2))yields varied outcomes across several studies.This study aimed to determine the ability of the change in ScvO_(2)(ΔScvO_(2))to detect fluid responsiveness in ventilated septic shock patients and potential influencing factors.Methods:In this prospective,single-center study,all patients conducted from February 2023 to January 2024 received fluid challenge.Oxygen consumption was measured by indirect calorimetry,and fluid responsiveness was defined as an increase in cardiac index(CI)≥10%measured by transthoracic echocardiography.Multivariate linear regression analysis was conducted to evaluate the impact of oxygen consumption,arterial oxygen saturation,CI,and hemoglobin on ScvO_(2)and its change before and after fluid challenge.The Shapiro-Wilk test was used for the normality of continuous data.Data comparison between fluid responders and non-responders was conducted using a two-tailed Student t-test,Mann Whitney U test,and Chi-square test.Paired t-tests were used for normally distributed data,while the Wilcoxon signed-rank test was used for skewed data,to compare data before and after fluid challenge.Results:Among 49 patients(31 men,aged(59±18)years),27 were responders.The patients had an acute physiology and chronic health evaluation II score of 24±8,a sequential organ failure assessment score of 11±4,and a blood lactate level of(3.2±3.1)mmol/L at enrollment.After the fluid challenge,theΔScvO_(2)(mmHg)in the responders was greater than that in the non-responders(4±6 vs.1±3,p=0.019).Multivariate linear regression analysis suggested that CI was the only independent influencing factor of ScvO_(2),with R2=0.063,p=0.008.After the fluid challenge,the change in CI became the only contributing factor toΔScvO_(2)(R2=0.245,p<0.001).ΔScvO_(2)had a good discriminatory ability for the responders and non-responders with a threshold of 4.4%(area under the curve=0.732,p=0.006).Conclusion:ΔScvO_(2)served as a reliable surrogate marker forΔCI and could be utilized to assess fluid responsiveness,given that the change in CI was the sole contributing factor to theΔScvO_(2).In stable hemoglobin conditions,the absolute value of ScvO_(2)could serve as a monitoring indicator for adequate oxygen delivery independent of oxygen consumption.
