目的 探讨烧伤脓毒症患者的氧供、氧 耗、氧摄取率特点及其变化与临床转归的关系。方法 对1993年3月～1998 年9月收治的烧伤脓毒症患者32例进行Swan-Ganz漂浮导管监测，并根据同时间点的动、 静脉血氧分压、氧饱和度、血红蛋白，计算氧供、氧耗量及氧摄取率。结果 脓毒症出现后，氧供、氧耗及氧摄取率明显增加，随病情好转，氧供、氧耗量及氧摄 取率逐步恢复，但观察期内仍高于正常水平；而并发MODS患者首先表现为氧供量增加，但氧 耗量及氧摄取率低于单纯脓毒症病人，出现氧耗量脱离氧供的假象，机体酸中毒显著。脓毒 症并发MODS死亡患者临终前氧供、氧耗量、氧摄取率均低于成活者。结论 高代谢是烧伤和脓毒症患者的临床表现之一。因此，保证机体充足氧供、减少氧耗量、提 高组织细胞氧摄取率是避免器官、细胞损伤进一步加重的重要措施之一。%Objective To explore the characteristics of oxygen delivery, oxygen consumption and oxygen extraction ratio in burn patie nts with sepsis,and to analyze the relationship between the clinical prognosis a nd oxygen metabolism.Methods Thirty-two burn patients with sep sis admitted to our Burn Institute from March 1993 to September 1998 were analyz ed. The Swan-Ganz catheter was inserted for monitoring hemodynamics.According t o the arterial and venous partial pressure of oxygen, oxygen saturation and hem oglobin,the oxygen delivery, amount of oxygen consumption and oxygen extraction ratio were calculated.Results The increases in oxygen delivery, amount of oxygen consumption and oxygen extraction ratio were observed when the sepsis emerged.They were gradually restored as the conditions of the patients b ecame stable, but still higher than the normal throughout the course of the obse rvation. However, when the patients developed MODS，the amount of oxygen consump tion and oxygen extraction ratio were lower than those in the patients without M ODS despite an increase in DO2, showing a different pattern of dependency of VO2 to DO2, and severe acidosis was manifested. Oxygen delivery, amount of oxygen consumption and oxygen extraction ratio at the terminal stage o f MODS subsequent to sepsis were obviously lower than those of the survivors.Conclusion Hypermetabolism is one of the clinical manifestations i n patients with sepsis, therefore, to ensure an ample oxygen delivery,reduce amo unt of oxygen consumption and improve tissue oxygen extraction ratio should be t he importance measures to avoid tissue damage.
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