中心静脉-动脉血二氧化碳分压差联合液体负荷状态评价感染性休克预后的价值

摘要

目的 探讨中心静脉-动脉血二氧化碳分压差[central venous-arterial carbon dioxide partial difference,P(cv-a)CO2]联合液体负荷状态评价感染性休克预后的价值.方法 收集2015年10月—2017年3月我科收治的95例感染性休克患者资料,依据治疗72 h后有无液体过负荷及P(cv-a)CO2将患者分为4组,A组为液体过负荷+P(cv-a)CO2≥6 mmHg(1 mmHg=0.133 kPa);B组为非液体过负荷+P(cv-a)CO2≥6 mmHg;C组为液体过负荷+P(cv-a)CO2<6 mmHg;D组为非液体过负荷+P(cv-a)CO2<6 mmHg,比较各组28 d和90 d的病死率、机械通气时间、ICU住院时间、住院时间的差异.结果 4组间机械通气时间、ICU住院时间、住院时间、28 d和90 d的病死率差异均有统计学意义(P<0.05).结论 P(cv-a)CO2和液体过负荷状态可以联合评价感染性休克的预后.%Objective To evaluate the value of P(cv-a)CO2 combined with fluid load status in assessing prognosis of patients with septic shock.Methods The data of 95 patients with septic shock were collected from October 2015 to March 2017, and the included patients were divided into 4 groups according to the presence of fluid overload and P(cv-a)CO2 threshold of 6 mmHg (1 mmHg=0.133 kPa) 72 hours after treatment. Group A: fluid overload + P(cv-a)CO2≥6 mmHg; Group B: non-fluid overload + P(cv-a) CO2≥6 mmHg; Group C: fluid overload + P(cv-a)CO2<6 mmHg; Group D: non-fluid overload + P(cv-a)CO2<6 mmHg. The differences in the mortality rate on 28 and 90 days, mechanical ventilation time, ICU time, and hospital stay time were compared among the four groups.Results There were statistically significant differences in mechanical ventilation time, ICU time, hospital stay, 28-day mortality and 90-day mortality among the 4 groups (P<0.05).Conclusions The combination of P(cv-a)CO2 and fluid overload condition can evaluate the prognosis of patients with septic shock.