Wang Dong-hao, Lv Yang, Xia Rui, Yang Yang, Liu Kun-bin, Han Tao
Tianjin Medical University Cancer Hospital, Tianjin, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2011 Nov;23(11):669-72.
To evaluate the hemodynamic state of critically ill cancer patients using central venous-to-arterial carbon dioxide difference (Pcv-aCO(2)) and to direct the treatment.
Clinical data of 47 cancer critically ill patients with acute physiology and chronic health evaluation II (APACHE II) score> 15 and unstable hemodynamic state were enrolled from intensive care unit of Tianjin Medical University Cancer Hospital from October 1st 2010 to May 31th 2011, were analyzed retrospectively. The patients were receiving the standard treatment according to the guidelines for 24 hours, the end-point of therapy was the standard of early goal direct therapy (EGDT). According to difference of sequential organ failure scores (ΔSOFA) of that after treatment and before treatment, the patients were divided into two groups: ΔSOFA≤ 1 (n = 27) and ΔSOFA> 1 (n = 20). The mean arterial pressure (MAP), urine output per hour, central venous pressure (CVP), oxygen saturation of central venous blood (ScvO(2)), the clearance of lactic acid, and Pcv-aCO(2) before treatment were compared with those after treatment, and their correlation with ΔSOFA was analysed.
There were no significant differences in MAP (mm Hg, 1 mm Hg = 0.133 kPa: 54.48 ± 4.95 vs. 54.45 ± 4.30), urine output per hour (ml:19.33 ± 4.53 vs. 20.55 ± 5.54), CVP(mm Hg: 3.48 ± 1.81 vs. 3.25 ± 1.16), ScvO(2) (0.571 ± 0.042 vs. 0.578 ± 0.047) of two groups before treatment (all P > 0.05), but in the group ΔSOFA≤1, the Pcv-aCO(2) (mm Hg: 7.80 ± 2.20 vs. 9.39 ± 0.97) and SOFA scores (6.33 ± 2.11 vs. 9.50 ± 1.24) were significantly lower than those of the group ΔSOFA>1 (all P < 0.01). There were no significant differences in MAP (mm Hg: 73.48 ± 6.12 vs. 71.30 ± 7.30), CVP (mm Hg: 6.85 ± 1.26 vs. 6.50 ± 1.28), ScvO(2) (0.693 ± 0.032 vs. 0.684 ± 0.039) between two groups after treatment (all P > 0.05), though their
data were improved compared with that of before treatment. However, there were significant differences in Pcv-aCO(2) (mm Hg: 3.02 ± 1.59 vs. 8.21 ± 2.23), urine output per hour (ml: 71.41 ± 6.74 vs. 51.70 ± 7.50), SOFA score (6.03 ± 2.56 vs. 10.05 ± 1.61), the clearance of lactic acid [(27.71 ± 11.46)% vs. -(0.78 ± 13.29)%, all P < 0.01]. There was significant correlation between urine output per hour, Pcv-aCO(2), clearance of lactic acid and ΔSOFA (r values were -0.712, 0.745, -0.631, all P < 0.05).
Pcv-aCO(2) could be used as an index of evaluating the cardiac index and the hemodynamic state, and it could be considered to be one of the indices of evaluating the therapeutic effect and prognosis.
采用中心静脉 - 动脉血二氧化碳分压差（Pcv-aCO₂）评估危重症癌症患者的血流动力学状态，并指导治疗。
回顾性分析2010年10月1日至2011年5月31日天津医科大学肿瘤医院重症监护病房收治的47例急性生理与慢性健康状况评分II（APACHE II）>15分且血流动力学不稳定的癌症危重症患者的临床资料。患者接受24小时标准指南治疗，治疗终点为早期目标导向治疗（EGDT）标准。根据治疗前后序贯器官衰竭评分（ΔSOFA）的差异，将患者分为两组：ΔSOFA≤1（n = 27）和ΔSOFA>1（n = 20）。比较两组治疗前后的平均动脉压（MAP）、每小时尿量、中心静脉压（CVP）、中心静脉血氧饱和度（ScvO₂）、乳酸清除率及Pcv-aCO₂，并分析它们与ΔSOFA的相关性。
两组治疗前MAP（mmHg，1 mmHg = 0.133 kPa：54.48 ± 4.95 vs. 54.45 ± 4.30）、每小时尿量（ml：19.33 ± 4.53 vs. 20.55 ± 5.54）、CVP（mmHg：3.48 ± 1.81 vs. 3.25 ± 1.16）、ScvO₂（0.571 ± 0.042 vs. 0.578 ± 0.047）比较，差异均无统计学意义（均P > 0.05），但ΔSOFA≤1组的Pcv-aCO₂（mmHg：7.80 ± 2.20 vs. 9.39 ± 0.97）和SOFA评分（6.33 ± 2.11 vs. 9.50 ± 1.24）显著低于ΔSOFA>1组（均P < 0.01）。两组治疗后MAP（mmHg：73.48 ± 6.12 vs. 71.30 ± 7.30）、CVP（mmHg：6.85 ± 1.26 vs. 6.50 ± 1.28）、ScvO₂（0.693 ± 0.032 vs. 0.684 ± 0.039）比较，差异均无统计学意义（均P > 0.05），尽管与治疗前相比有所改善。然而，两组治疗后Pcv-aCO₂（mmHg：3.02 ± 1.59 vs. 8.21 ± 2.23）、每小时尿量（ml：71.41 ± 6.74 vs. 51.70 ± 7.50）、SOFA评分（6.03 ± 2.56 vs. 10.05 ± 1.61）、乳酸清除率[（27.71 ± 11.46）% vs. -（0.78 ± 13.29）%，均P < 0.01]差异有统计学意义。每小时尿量、Pcv-aCO₂、乳酸清除率与ΔSOFA之间存在显著相关性（r值分别为 -0.712、0.745、 -0.631，均P < 0.05）。
Pcv-aCO₂可作为评估心脏指数和血流动力学状态的指标，可考虑作为评估治疗效果和预后的指标之一。
