【摘要】 目的观察液体复苏对感染性休克患者血气分析、酸碱平衡、电解质、急性生理和慢性健康状况评估Ⅱ(APACHEⅡ)评分的影响,进而分析它们与复苏液体总量的相关性,并探讨其临床意义。方法 24h达标(中心静脉压8～12mmHg、平均动脉血压≥65mmHg)复苏治疗21例符合本研究入选标准的感染性休克患者,前瞻性自身比较复苏治疗前及复苏治疗24h后血气分析、酸碱平衡、电解质及APACHEⅡ评分,直线回归分析电解质、酸碱、血气分析指标及APACHEⅡ评分与复苏液体总量的相关性。结果 21例感染性休克患者24h内复苏液体总量为(7775±1735)mL(5320～11028mL),复苏达标时间为(18.09±4.57)h。复苏治疗24h后血Na+(mmol/L)和Cl-(mmol/L)均较治疗前明显升高(Na+:138.71±5.67比135.62±7.23,P=0.024;Cl-:109.10±4.90比101.67±8.59,P=0.000);血pH值、红细胞比容(Hct,%)、阴离子隙(AG,mmol/L)、乳酸(mmol/L)及APACHEⅡ评分(分)均较治疗前明显下降(pH:7.31±0.05比7.37±0.06,P=0.000;Hct:28.48±2.56比32.76±9.19,P=0.049;AG:8.33±3.45比14.17±8.83,P=0.004;乳酸:1.66±0.89比2.96±1.23,P=0.001;APACHEⅡ评分:10.90±3.73比17.24±4.06,P=0.000)。血Cl-水平与复苏液体总量呈正相关(r=0.717,P<0.01)、其余电解质、酸碱、血气分析指标及APACHEⅡ评分与复苏液体总量无相关性(P>0.05)。结论感染性休克患者应制定适宜的液体复苏目标,并监测内环境的变化,尽可能控制晶体液输入量及不良内环境影响。复苏治疗减轻病情与输注液体总量无明显相关。更多还原

【Abstract】 Objective To evaluate the effects and the clinical significances of liquid resuscitation on blood gas analysis,acid-base balance,electrolytes,acute physiology and chronic health evaluationsⅡ(APACHEⅡ) score of patients with septic shock,and then to analyze the relations between serum chlorine(Cl-) level and APACHEⅡscore and the volume of liquid resuscitation.Methods According to the target of resuscitation(centre venous pressure 8-12?mm Hg and mean arterial pressure≥65?mm Hg),21 patients with septic shock received enough fluid for resuscitation during 24?h.The results of blood gas analysis,acid-base balance,electrolytes,and APACHE Ⅱ score were compared between pre-resuscitation and 24?h post-resuscitation by self-controlled prospective study.The relationships of the level of serum Cl-and APACHEⅡ score with the volume of liquid used in resuscitation were analyzed.Results The mean resuscitation duration was(18.09±4.57) h,and the volume of liquid during 24 h resuscitation was 5 320-11 028?mL with mean volume of(7 775±1 735) mL in 21 patients with septic shock.Serum sodium(Na+,mmol/L) and Cl-?(mmol/L) levels of post-resuscitation were significant higher than those of pre-resuscitation(Na+:138.71±5.67 versus 135.62±7.23,P=0.024;Cl-:109.10±4.90 versus 101.67±8.59,P=0.000).Compared with the levels of pre-resuscitation,the blood pH value,hematocrit(Hct,%),anion gap(AG,mmol/L),lactic acid(mmol/L),and APACHE Ⅱ score significantly decreased(pH:7.31±0.05 versus 7.37±0.06,P=0.000;Hct:28.48±2.56 versus 32.76± 9.19,P=0.049;AG:8.33±3.45 versus 14.17±8.83,P=0.004;lactic acid:1.66±0.89 versus 2.96±1.23,P= 0.001;APACHEⅡ:10.90±3.73 versus 17.24±4.06,P=0.000) after 24?h resuscitation.The correlation analysis showed that the level of serum Cl-was positively correlated with the volume of liquid used in resuscitation(r=0.717, P<0.01).However,there was no correlation between APACHEⅡscore and the volume of liquid used in resuscitation(P> 0.05).Conclusions The target of liquid resuscitation in patients with septic shock should be cautiously determined,including control of the volume of crystal liquid for resuscitation,in order to avoid acid-base imbalance or hyperchloraemia.At the same time,the change in internal environment should be monitored.An optimistic fluid resuscitation to decrease APACHE Ⅱ score in patients with septic shock is unrelated to the volume of liquid resuscitation.更多还原