[乳酸清除率和中心静脉血氧饱和度指导下的液体复苏对感染性休克患者的疗效]
[Efficacies of fluid resuscitation as guided by lactate clearance rate and central venous oxygen saturation in patients with septic shock].
作者信息
Lyu Xiaochun, Xu Qianghong, Cai Guolong, Yan Jing, Yan Molei
机构信息
Department of Critical Care, Zhejiang Hospital, Hangzhou 310013, China.
Department of Critical Care, Zhejiang Hospital, Hangzhou 310013, China. Email:
出版信息
Zhonghua Yi Xue Za Zhi. 2015 Feb 17;95(7):496-500.
OBJECTIVE
To estimate the efficacies of fluid resuscitations as guided by lactate clearance rate (LC) and central venous oxygen saturation (ScvO₂) in patients with septic shock.
METHODS
100 patients diagnosed with septic shock from June 2012 to June 2014 in department of critical care medicine of sixteen hospitals were enrolled. They were randomly divided into two groups of study and control (each n = 50). After a diagnosis of sepsis shock, they were treated symptomatically timely and fluid resuscitation was started as early as possible according to the 2008 Guideline for Managing Sepsis & Septic Shock. Central venous pressure (CVP) ≥ 8 mmHg (1 mmHg = 0.133 kPa), mean arterial pressure (MAP) ≥ 65 mmHg, urine output ≥ 0.5 ml × kg⁻¹ × h⁻¹, ScvO₂≥ 70% and LC ≥ 10% (or lactate ≤ 2.0 mmol) served as target values for fluid resuscitation therapy in study group versus CVP ≥ 8 mmHg, MAP ≥ 65 mmHg, urine output ≥ 0.5 ml × kg⁻¹ × h⁻¹ and ScvO₂≥ 70% in control group. The general conditions and clinical characteristics, changes in CVP, MAP, urine output, ScvO₂, lactate level and/or LC before (0 hour) and every hour (1-6 h) after the start of fluid resuscitation and other related outcome indicators were recorded.
RESULTS
No significant difference existed in general data. The 28-day mortality was 40% for study group versus 56% for control group. There was no significant inter-group difference (P > 0.05). The time of mechanical ventilation and length of intensive care unit (ICU) stay were lower in study group than those in control group [mechanical ventilation time (11.200 ± 17.069) vs (15.760 ± 14.215), P = 0.150; length of ICU stay (13.240 ± 17.127) vs (23.980 ± 18.298), P = 0.003]. The 28-day mortality was independently associated with LC and ScvO₂reaching target values for fluid resuscitation in study group (χ² = 10.930, P = 0.001) while the 28-day mortality was independently associated with ScvO₂reaching target value for fluid resuscitation in control group (χ² = 6.395, P = 0.011). Among all patients, the 28-day mortality was independently associated with ScvO₂reaching target value for fluid resuscitation (χ² = 14.530, P = 0.000), but not LC (χ² = 1.175, P = 0.278).
CONCLUSION
A combination of LC and ScvO₂may serve an index in confirming the endpoint of fluid resuscitation for patients with septic shock. Fluid resuscitation therapy under the guidance of LC and ScvO₂is more accurate and reliable than the guidance of ScvO₂alone.
目的
评估以乳酸清除率（LC）和中心静脉血氧饱和度（ScvO₂）为指导的液体复苏对感染性休克患者的疗效。
方法
选取2012年6月至2014年6月在16家医院重症医学科诊断为感染性休克的100例患者。将他们随机分为研究组和对照组，每组各50例。确诊为感染性休克后，及时进行对症治疗，并根据2008年《脓毒症及感染性休克治疗指南》尽早开始液体复苏。研究组液体复苏治疗的目标值为中心静脉压（CVP）≥8 mmHg（1 mmHg = 0.133 kPa）、平均动脉压（MAP）≥65 mmHg、尿量≥0.5 ml×kg⁻¹×h⁻¹、ScvO₂≥70%且LC≥10%（或乳酸≤2.0 mmol），而对照组为CVP≥8 mmHg、MAP≥65 mmHg、尿量≥0.5 ml×kg⁻¹×h⁻¹且ScvO₂≥70%。记录患者的一般情况和临床特征，以及液体复苏开始前（0小时）和开始后每小时（1 - 6小时）CVP、MAP、尿量、ScvO₂、乳酸水平和/或LC的变化及其他相关结局指标。
结果
两组一般资料无显著差异。研究组28天死亡率为40%，对照组为56%。组间差异无统计学意义（P > 0.05）。研究组机械通气时间和重症监护病房（ICU）住院时间低于对照组[机械通气时间（11.200 ± 17.069）对（15.760 ± 14.215），P = 0.150；ICU住院时间（13.240 ± 17.127）对（23.980 ± 18.298），P = 0.003]。研究组28天死亡率与液体复苏达到目标值的LC和ScvO₂独立相关（χ² = 10.930，P = 0.001），而对照组28天死亡率与液体复苏达到目标值的ScvO₂独立相关（χ² = 6.395，P = 0.011）。在所有患者中，28天死亡率与液体复苏达到目标值的ScvO₂独立相关（χ² = 14.530，P = 0.000），但与LC无关（χ² = 1.175，P = 0.278）。
结论
LC和ScvO₂联合可作为确定感染性休克患者液体复苏终点的指标。以LC和ScvO₂为指导的液体复苏治疗比仅以ScvO₂为指导更准确可靠。
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