Zhao Hong-jie, Huang Ying-zi, Liu Ai-ran, Yang Cong-shan, Guo Feng-mei, Qiu Hai-bo, Yang Yi
Department of Critical Medicine, Zhong-Da Hospital and School of Clinical Medicine, Southeast University, Nanjing 210009, China.
Zhonghua Nei Ke Za Zhi. 2012 Jun;51(6):437-40.
To assess the value of central venous-to-arterial carbon dioxide difference [P((cv-a))CO₂] in evaluation of disease severity and prognosis in patients with septic shock.
There were 45 consecutive resuscitated septic shock patients from April 2009 to October 2010 included immediately after their admission into our ICU. The patients were divided into low P((cv-a))CO₂ group and high P((cv-a))CO₂ group according to a threshold of 6 mm Hg (1 mm Hg = 0.133 kPa). All patients were treated by early goal directed therapy (EGDT). The parameters of hemodynamics, lactate clearance rate, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, the sequential organ failure assessment (SOFA) score, 6 h rate of EGDT achievement, the ICU mortality and 28 days in-hospital mortality were recorded for all patients.
There were 30 patients in the low P((cv-a))CO₂ group, and 15 in the high P((cv-a))CO₂ group. There were no significant differences between low P((cv-a))CO₂ and high P((cv-a))CO₂ patients in age, APACHE II score and SOFA score (all P > 0.05). Compared with the high P((cv-a))CO₂ group, the low P((cv-a))CO₂ group had higher cardiac index (CI) and 24 h CI, higher delivery O₂ (DO₂) and 24 h DO₂, higher central venous oxygen saturation (ScvO₂) [(74 ± 9)% vs (67 ± 8)%], lower lactate [(3.4 ± 2.1) mmol/L vs (5.7 ± 4.5) mmol/L] and higher ΔSOFA score [(0.7 ± 1.8) vs (-0.4 ± 1.1)], lower 24 h SOFA score [(7.8 ± 2.0) vs (9.8 ± 2.0)], higher 6 h rate of EGDT achievement (83.3% vs 53.3%) (P < 0.05), however, there were no differences in 28 days mortality and ICU mortality between the two groups (P > 0.05).
P((cv-a))CO₂ might be an indicator for predicting the severity of patients with septic shock and evaluating tissue perfusion.
评估中心静脉 - 动脉血二氧化碳分压差[P((cv - a))CO₂]在评估感染性休克患者疾病严重程度及预后中的价值。
选取2009年4月至2010年10月期间连续收治入重症监护病房（ICU）且复苏后的45例感染性休克患者，患者入院后立即纳入研究。根据6 mmHg（1 mmHg = 0.133 kPa）的阈值将患者分为低P((cv - a))CO₂组和高P((cv - a))CO₂组。所有患者均接受早期目标导向治疗（EGDT）。记录所有患者的血流动力学参数、乳酸清除率、急性生理与慢性健康状况评分系统II（APACHE II）评分、序贯器官衰竭评估（SOFA）评分、EGDT达标6小时率、ICU死亡率及28天住院死亡率。
低P((cv - a))CO₂组30例患者，高P((cv - a))CO₂组15例患者。低P((cv - a))CO₂组与高P((cv - a))CO₂组患者在年龄、APACHE II评分及SOFA评分方面差异均无统计学意义（均P > 0.05）。与高P((cv - a))CO₂组相比，低P((cv - a))CO₂组心脏指数（CI）及24小时CI更高；氧输送（DO₂）及24小时DO₂更高；中心静脉血氧饱和度（ScvO₂）更高[（74 ± 9）% 对 （67 ± 8）%]；乳酸水平更低[（3.4 ± 2.1）mmol/L对（5.7 ± 4.5）mmol/L]；ΔSOFA评分更高[（0.7 ± 1.8）对（ - 0.4 ± 1.1）]；24小时SOFA评分更低[（7.8 ± 2.0）对（9.8 ± 2.0）]；EGDT达标6小时率更高（83.3%对53.3%）（P < 0.05），然而，两组患者28天死亡率及ICU死亡率差异无统计学意义（P > 0.05）。
P((cv - a))CO₂可能是预测感染性休克患者病情严重程度及评估组织灌注的一个指标。
