Rady M Y, Rivers E P, Nowak R M
Department of Critical Care Medicine, Cleveland Clinic Foundation, OH, USA.
Am J Emerg Med. 1996 Mar;14(2):218-25. doi: 10.1016/s0735-6757(96)90136-9.
To describe the simultaneous responses of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), heart rate (HR), shock index (SI = HR/SBP), central venous oxyhemoglobin saturation (ScvO2), and arterial blood lactate concentration (Lact) to resuscitation of critically ill patients in the emergency department (ED), an observational descriptive study was conducted in the ED of an urban teaching hospital. Thirty- six patients admitted from the ED to the medical intensive care unit were studied. Vital signs were measured immediately on arrival to the ED (phase 1). After initial resuscitation and stabilization, ie, HR between 50 and 120 beats/min and MAP between 70 and 110 mm Hg (phase 2), ScvO2 and Lact were measured and additional therapy was given in the ED to increase ScvO2 to > 65% and decrease Lact to < 2 mmol/L, if needed (phase 3). SBP, DBP, MAP, HR. SI, ScvO2, and Lact were measured. Initial resuscitation increased SBP from 103 +/- 39 to 118 +/- 29 mm Hg (P < .05) and MAP from 67 +/- 35 to 82 +/- 22 mm Hg (P < .05) but did not affect DBP (53 +/- 35 to 63 +/- 22 mm Hg, P = NS), HR (110 +/- 26 to 110 +/- 22 beats/min, P = NS) or SI (from 1.3 +/- 0.7 to 1.0 +/- 0.3, P =NS) from phase 1 to phase 2. ScvO2 remained < 65% and/or Lact > 2.0 mmol/L in 31 of 36 patients at phase 2, and additional therapy was required. Lact was decreased (from 4.6 +/- 3.8 to 2.6 +/- 2.5 mmol/L, P < .05) and ScvO2 was increased (from 52 +/- 18 to 65 +/- 13%, P < .05) without significant additional changes in SBP, DBP, MAP, HR, or SI at phase 3. The in-hospital mortality was 14% for this group of patients. It was concluded that additional therapy is required in the majority of critically ill patients to restore adequate systemic oxygenation after initial resuscitation and hemodynamic stabilization in the ED. Additional therapy to increase ScvO2 and decrease Lact may not produce substantial responses in SBP, DBP, MAP, HR, and SI. The measurement of ScvO2 and Lact can be utilized to guide this phase of additional therapy in the ED.
为描述急诊室（ED）危重症患者复苏时收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、休克指数（SI = HR/SBP）、中心静脉血氧饱和度（ScvO2）和动脉血乳酸浓度（Lact）的同步反应，在一家城市教学医院的急诊室开展了一项观察性描述性研究。研究了36例从急诊室收治至医学重症监护病房的患者。患者抵达急诊室时立即测量生命体征（阶段1）。在初始复苏和病情稳定后，即心率在50至120次/分钟之间且平均动脉压在70至110 mmHg之间（阶段2），测量ScvO2和Lact，如有必要，在急诊室给予额外治疗以将ScvO2提高至> 65%并将Lact降低至< 2 mmol/L（阶段3）。测量SBP、DBP、MAP、HR、SI、ScvO2和Lact。初始复苏使收缩压从103±39 mmHg升至118±29 mmHg（P <.05），平均动脉压从67±35 mmHg升至82±22 mmHg（P <.05），但未影响舒张压（从53±35 mmHg升至63±22 mmHg，P =无统计学意义）、心率（从110±26次/分钟升至110±22次/分钟，P =无统计学意义）或休克指数（从1.3±0.7降至1.0±0.3，P =无统计学意义），从阶段1至阶段2。在阶段2，36例患者中有31例ScvO2仍< 65%和/或Lact> 2.0 mmol/L，需要额外治疗。阶段3时，乳酸降低（从4.6±3.8 mmol/L降至2.6±2.5 mmol/L，P <.05），ScvO2升高（从52±18%升至65±13%，P <.05），而SBP、DBP、MAP、HR或SI无显著额外变化。该组患者的院内死亡率为14%。得出的结论是，大多数危重症患者在急诊室初始复苏和血流动力学稳定后需要额外治疗以恢复足够的全身氧合。增加ScvO2和降低Lact的额外治疗可能不会使SBP、DBP、MAP、HR和SI产生实质性反应。ScvO2和Lact的测量可用于指导急诊室这一阶段的额外治疗。
