Zhang Lina, Ai Yuhang, Liu Zhiyong, Ma Xinhua, Ming Guangfeng, Zhao Shuangping, Xu Daomiao
Department of Intensive Care Unit, Xiangya Hospital, Central South University, Changsha 410008, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2012 Apr;37(4):332-7. doi: 10.3969/j.issn.1672-7347.2012.04.002.
To determine whether central venous-to-arterial carbon dioxide tension difference (Pcv-aCO(2)) could still be used as a goal of fluid resuscitation in septic patients who already had ScvO2 greater than 70% after early resuscitation.
A prospective observational study was performed on 56 septic patients admitted to the Intensive Care Unit (ICU) in a single University Hospital, who already had ScvO2 greater than 70% after early resuscitation. They were divided into two groups, based on whether the patients' initial Pcv-aCO2 was less than 6 mmHg (low gap group) or greater than or equal to 6 mmHg (high gap group). The following data were collected at 0, 12, and 24 hours (T(0), T(12), T(24)) after study inclusion: hemodynamic indices [mean blood pressure (MAP), heart rate (HR), cardiac output (CO), central venous pressure (CVP)], perfusion-related indexes [ScvO(2), Pcv-aCO2, serum lactate (Lac), Lac clearance rate], organ function- related indices [oxygenation index (PaO2/FiO(2)), serum creatinine (SCr), creatine kinase (CK-MB)], APACHE II score, SOFA score, and 24 hours amounts of fluid infusion.
Twenty patients (42.9%) with initial Pcv-aCO(2) ≥ 6 mmHg were included in the high gap group and another thirty-two patients were included in the low gap group. At T12 and T24, ScvO(2) and CO were significantly higher, and Lac and SCr were significantly lower in low gap patients than high gap patients (P<0.05). At T(12) and T(24), Lac clearance rate was significantly higher (P<0.05), and 24-hours amounts of fluid infusion was significantly less [(3449.47 ± 695.41) mL vs (4070.66 ± 757.43) mL, P= 0.002] for the low gap group than for the high gap group, as well as the descrease of SOFA score at T(24) (P<0.05). There was no significant difference of APACHE II score between the 2 groups (P<0.05). CO and Pcv-aCO(2) values were inversely correlated (P< 0.05).
Septic patients targeting only ScvO(2) may still have inappropriate tissue perfusion, especially when Pcv-aCO2 ≥6 mmHg, which indicates insufficient resuscitation. When ScvO(2) > 70% has achieved after early resuscitation, Pcv-aCO2 can still be used as a goal of fluid resuscitation in septic patients .
确定在早期复苏后已达到中心静脉血氧饱和度（ScvO₂）大于70%的脓毒症患者中，中心静脉 - 动脉血二氧化碳分压差值（Pcv - aCO₂）是否仍可作为液体复苏的目标。
对一所大学医院重症监护病房（ICU）收治的56例脓毒症患者进行前瞻性观察研究，这些患者在早期复苏后ScvO₂已大于70%。根据患者初始Pcv - aCO₂是否小于6 mmHg（低差值组）或大于或等于6 mmHg（高差值组）将他们分为两组。在纳入研究后的0、12和24小时（T₀、T₁₂、T₂₄）收集以下数据：血流动力学指标[平均动脉压（MAP）、心率（HR）、心输出量（CO）、中心静脉压（CVP）]，灌注相关指标[ScvO₂、Pcv - aCO₂、血清乳酸（Lac）、乳酸清除率]，器官功能相关指标[氧合指数（PaO₂/FiO₂）、血清肌酐（SCr）、肌酸激酶（CK - MB）]，急性生理与慢性健康状况评分系统（APACHE II）评分、序贯器官衰竭评估（SOFA）评分以及24小时液体输注量。
初始Pcv - aCO₂≥6 mmHg的20例患者（42.9%）被纳入高差值组，另外32例患者被纳入低差值组。在T₁₂和T₂₄时，低差值组患者的ScvO₂和CO显著更高，而Lac和SCr显著更低（P<0.05）。在T₁₂和T₂₄时，低差值组的乳酸清除率显著更高（P<0.05），24小时液体输注量显著更少[（3449.47±695.41）mL对（4070.66±757.43）mL，P = 0.002]，并且在T₂₄时SOFA评分的下降幅度更大（P<0.05）。两组之间的APACHE II评分无显著差异（P>0.05）。CO与Pcv - aCO₂值呈负相关（P<0.05）。
仅以ScvO₂为目标的脓毒症患者可能仍存在组织灌注不充分的情况，特别是当Pcv - aCO₂≥6 mmHg时，这表明复苏不足。当早期复苏后ScvO₂>70%时，Pcv - aCO₂仍可作为脓毒症患者液体复苏的目标。
