中心静脉血氧饱和度联合乳酸清除率在休克中的应用
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摘要
目的探讨中心静脉血氧饱和度联合乳酸清除率在休克中的应用。方法所有患者均建立锁骨下静脉或颈内静脉置管。行血气分析测定两组的中心静脉血氧饱和度和乳酸水平,监测6 h乳酸清除率。以7 d为观察终点,观察两组患者的MODS发生率和死亡率。(MODS的诊断标准参照fry-MODS诊断标准)。结果 A组患者为ScvO2<65%,6 h乳酸清除率<10%,B组患者为ScvO2>65%,6 h乳酸清除率>10%。治疗后两组患者中心静脉压和乳酸均有好转,MODS发生率和死亡率B组明显优于A组,差异有统计学意义(P<0.05)。结论 ScvO2联合乳酸清除率对休克患者的早期复苏具有重要的指导意义,也是评估患者后期预后的重要指标。
Objective To discuss center venous blood oxygen degree of saturation union lactic acid percentage clearance in shock application.Methods All patients establish the subclavian vein or the vena jugularis interna set at the tube. The good courage vigor analysis determines two group of central venous blood oxygen degree of saturation and the lactic acid level, monitors 6 hour lactic acid percentage clearances. Take 7 d as the observation end point, observes two group of patient' s MODS formation rates and the mortality rate. Results A group of patients are the ScvO2<65%,6 hour lactic acid percentage clearance <10%, B group of patients are the ScvO2>65%,6 hour lactic acid percentage clearance >10%.Treats the latter two group of patient center venous pressure and the lactic acid has the change for the better, the MODS formation rate and the mortality rate B group surpasses A group obviously, the difference has statistics significance(P<0.05). Conclusion ScvO2 union lactic acid percentage clearance has the important guiding sense to the shock patient' s early anabiosis, also is appraises the patient later period the prognosis important target.
Objective To discuss center venous blood oxygen degree of saturation union lactic acid percentage clearance in shock application.Methods All patients establish the subclavian vein or the vena jugularis interna set at the tube. The good courage vigor analysis determines two group of central venous blood oxygen degree of saturation and the lactic acid level, monitors 6 hour lactic acid percentage clearances. Take 7 d as the observation end point, observes two group of patient' s MODS formation rates and the mortality rate. Results A group of patients are the ScvO2<65%,6 hour lactic acid percentage clearance <10%, B group of patients are the ScvO2>65%,6 hour lactic acid percentage clearance >10%.Treats the latter two group of patient center venous pressure and the lactic acid has the change for the better, the MODS formation rate and the mortality rate B group surpasses A group obviously, the difference has statistics significance(P<0.05). Conclusion ScvO2 union lactic acid percentage clearance has the important guiding sense to the shock patient' s early anabiosis, also is appraises the patient later period the prognosis important target.
引文
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[6]于斌,田慧艳,胡振杰,等.乳酸清除率评估严重休克患者早期液体复苏效果的可靠性[J].中华麻醉学杂志,2014,34(11):1372-1374.
[7]庄水龙.床旁超声半定量监测血管外肺水联合下腔静脉宽度在脓毒性休克患者早期液体复苏治疗中的应用价值[J].世界临床医学,2016,10(23):8-9.
[8] Parner A, Haase N, Guttormsen A, et al. Hydroxyethyl Starch Versus Ringers Acetate in Severe Sepsis[J]. N EngI J Med, 2012,367(3):124-134.
[9]连晓芳,李夏,王平,等.中心静脉血氧和度与乳酸在感染性休克的价值探讨[J].中国急救医学,2017,29(2):19-22.
[2] Leung JJ, Kangnkasis, Adamicza A, et al. Castro of Sepsis 3.0 and Guidelines for International Treatment of Septic Shock(2016 Edition)[J]. EXP Neurol,2016,211(4):8-12.
[3]邱海波.ICU主治医师手册[M].南京:江苏科技出版社,2015:292-294.
[4]刘大为.实用重症医学[M].北京:人民卫生出版社,2015:51-55.
[5]李亚红.乳酸清除率对休克早期液体复苏治疗的指导价值[J].中华临床医师杂志,2012,6(17):5354-5355.
[6]于斌,田慧艳,胡振杰,等.乳酸清除率评估严重休克患者早期液体复苏效果的可靠性[J].中华麻醉学杂志,2014,34(11):1372-1374.
[7]庄水龙.床旁超声半定量监测血管外肺水联合下腔静脉宽度在脓毒性休克患者早期液体复苏治疗中的应用价值[J].世界临床医学,2016,10(23):8-9.
[8] Parner A, Haase N, Guttormsen A, et al. Hydroxyethyl Starch Versus Ringers Acetate in Severe Sepsis[J]. N EngI J Med, 2012,367(3):124-134.
[9]连晓芳,李夏,王平,等.中心静脉血氧和度与乳酸在感染性休克的价值探讨[J].中国急救医学,2017,29(2):19-22.