容量状态对革兰氏阴性杆菌感染性休克患者血液动力学类型及氧代谢的影响

摘要

目的 探讨容量状态对感染性休克患者血液动力学状态及氧化谢的影响。方法 监测10例感染性休克患者不同容量状态下血液动力学及氧化谢的变化。结果 低血容量时，肺动脉嵌压(PAWP)0.8±0.3kPa，心脏指数(CI)2.0±0.4L.min-1.m-2，体循环阻力指数(SVRI)为3291.9±810.6dyn.s.cm-5.m2，血液动力学呈低排高阻型。通过液体复苏，使患者前负荷接近正常，PAWP达到1.6±0.4kPa时，CI显著升高，达3.9±0.9L.min-1.m-2(P＜0.05)，SVRI显著降低至1362.2±382.9dyn.s.cm-5.m2(P＜0.05)，血液动力学状态转化为高排低阻型。与之相对应，在液体复苏前后，氧输送指数(DO2)由284.3±77.0显著升至558.5±131.1ml.min-1.m-2(P＜0.05),氧耗指数(VO2)由99.7±52.3上升为140.7±45.0ml.min-1.m-2。结论 容量状态是影响感染性休克患者血液动力学类型的重要因素，液体复苏在感染性休克治疗中有重要意义。%Objective To observe the effect of preload on hemodynamic andoxygen metabolism in patients with septic shock.Methods 10 patients with septic shock induced by gram negative bacteria were admitted to this study group,parameters of hemodynamic and oxygen metabolism in defferent preload were measured.Results By fluid resuscitation,as the pulmonary artery wedge pressure increased from 0.8±0.3 to 1.6±0.4 kPa,cardiac index rose from 2.0±0.4 to 3.9±0.9 L.min-1.m-2,but systemic vascular resistance index decreased from 3 291.9±810.6 to 1 362.2±382.9 dyn.s.cm-5.m2 significantly (P＜0.05).Meanwhile,oxygen delivery index rose from 284.3±77.0 to 558.5±131.1 ml.min-1.m-2,and oxygen consumption index also increased from 99.7±52.3 to 140.7±45.0 ml.min-1.m-2 remarkably(P＜0.05).Conclusion Hemodynamic classification was decided by cardiac preload,fluid resuscitation is very important in septic shock therapy.