Silva Eliézer, De Backer Daniel, Creteur Jacques, Vincent Jean-Louis
Department of Intensive Care, Erasme University Hospital, Route de Lennik 808, 1070 Brussels, Belgium.
Intensive Care Med. 2004 Mar;30(3):423-9. doi: 10.1007/s00134-003-2115-2. Epub 2004 Jan 13.
To determine the effects of fluid challenge on systemic hemodynamic variables and gastric intramucosal partial pressure of carbon dioxide (PCO(2)) in septic patients.
Short-term interventional study.
Medical-surgical intensive care unit in a university hospital.
Twenty-four adult patients with severe sepsis or septic shock requiring volume replacement. All patients were studied within 24 h of onset of severe sepsis or septic shock.
Five hundred milliliters of a 6% hydroxyethyl starch (HES) solution were administered in 30 min.
Complete hemodynamic data, blood samples, and gastric mucosal PCO(2) (automatic gas capnometry) determinations were obtained at baseline and 15 min after the end of fluid infusion. After fluid challenge, cardiac index (CI) increased from 3.8 (range 2.9-4.2) to 4.2 (range 3.1-4.9) l/min m(-2) ( p<0.05). The PCO(2) gap decreased from 9.8 (range 6.9-26.0) to 8.5 (range 6.6-17.4) mm Hg ( p<0.05), but important individual variations were observed. We failed to observe significant relationships between changes in CI and in PCO(2) gap, or between indices of preload (pulmonary artery occluded pressure, right atrial pressure, and pulse pressure variations) and changes in PCO(2) gap. In addition, changes in PCO(2) gap and in (v-a) CO(2) were not related; however, changes in PCO(2) gap were related to baseline PCO(2) gap ( p=0.003), PEEP ( p=0.02), and cumulative doses of vasopressors ( p=0.02).
The effects of fluid challenge on gastric mucosal PCO(2) are variable and related to baseline PCO(2) gap rather than to systemic variables. In general, rapid volume infusion decreases PCO(2) gap, but this effect is more pronounced in patients with presumably impaired mucosal perfusion.
确定液体冲击对脓毒症患者全身血流动力学变量及胃黏膜二氧化碳分压（PCO₂）的影响。
短期干预性研究。
大学医院的内科-外科重症监护病房。
24例需要进行容量补充的严重脓毒症或脓毒性休克成年患者。所有患者均在严重脓毒症或脓毒性休克发作后24小时内接受研究。
在30分钟内输注500毫升6%羟乙基淀粉（HES）溶液。
在基线时以及输液结束后15分钟获取完整的血流动力学数据、血样和胃黏膜PCO₂（自动气体二氧化碳分压测定法）测定值。液体冲击后，心脏指数（CI）从3.8（范围2.9 - 4.2）升/分钟·平方米增加至4.2（范围3.1 - 4.9）（p<0.05）。PCO₂差值从9.8（范围6.9 - 26.0）毫米汞柱降至8.5（范围6.6 - 17.4）毫米汞柱（p<0.05），但观察到明显的个体差异。我们未观察到CI变化与PCO₂差值变化之间、前负荷指标（肺动脉闭塞压、右心房压和脉压变异）与PCO₂差值变化之间存在显著关系。此外，PCO₂差值变化与（动-静脉）二氧化碳分压差变化无关；然而，PCO₂差值变化与基线PCO₂差值（p = 0.003）、呼气末正压（PEEP）（p = 0.02）及血管升压药累积剂量（p = 0.02）相关。
液体冲击对胃黏膜PCO₂的影响是可变的，且与基线PCO₂差值相关而非与全身变量相关。一般而言，快速容量输注会降低PCO₂差值，但这种效应在推测黏膜灌注受损的患者中更为明显。
