【摘要】 目的研究感染性休克患者血流动力学变化与感染性休克的治疗方法。方法选择收治我院的感染性休克患者38例,由右侧颈内静脉置入Swan-Ganz导管,持续监测中心静脉压(CVP),肺动脉平均压(MPAP),肺毛细血管楔压(PCWP);计算外周血管阻力指数(SVRI)、心排指数(CI)和心率(HR)。分别于诊断当天(D0)、第3和5日(D3、D5)测定动脉血气分析,计算肺泡动脉血氧分压差[P(A-a)O2]、氧摄取率(O2extr)和肺内分流率(Qs/Qt)。按存活和死亡结果分组分析。结果与正常组比较,感染性休克患者MPAP、CI和HR明显升高,CVP、MAP、SVRI明显降低。前3天两组病人PaO2显著降低,P(A-a)O2和O2extr显著升高,生存组经治疗后可渐恢复正常,但第5天后,死亡组的PaO2和P(A-a)O2持续恶化;5天内两组患者的Qs/Qt均有升高。结论感染性休克患者存在外周血管扩张,有效循环血量减少,肺血管收缩,心排血量增高等高排低阻、和肺氧合功能受损的特点。感染性休克的治疗主要在于抗感染的病因治疗和维持组织灌注,纠正缺氧,调节机体炎性反应和尽早的营养支持等治疗。更多还原

【Abstract】 Objective to investigate the managements of patients with septic shock and changes in hemodynamics. Methods 38 patients with septic shock were included in this study. Swan-Ganz catheters were inserted and central venous pressure(CVP), mean pulmonary arterial pressure(MPAP),pulmonary capillary wedge pressure(PCWP), mean arterial pressure(MAP) and heart rate(HR) were measured. Meanwhile, on that day when septic shock was diagnosed, the third and fifth day, blood gas analysis was made and alveolar-arterial oxygen difference眼P(A-a)O2演,O2 extraction(O2extr), intrapulmonary shunt fraction(Qs/Qt), systemic vascular resistance index(SVRI), cardiac index(CI) were calculated. Results Compared to the control group, MPAP, CI and HR increased and CVP, MAP and SVRI decreased significantly in patients with septic shock. During the first three days, all patiences’ PaO2 degreased and P(A-a)O2 and O2extr enhanced significantly. In survival group, they could recover gradually but those in death group couldn’t. During the five days, all patients’ Qs/Qt enhanced. Conclusions In patients with septic shock, hemodynamics and oxygenation are characterized by peripheral angiectasia, decreased valid circulation volume, pulmonary vasoconstriction and heigh cardiac output, as well as oxygenation function impairation within the first five days diagnosed. The managements of septic shock include anti-infection for etilogical treatments, maintenance of organizational dabbling, rectification of hypoxia, modulation of organism inflammatory reaction and nutritional support as early as possible.更多还原