失血性休克动静脉血pH和PCO_2差变化及意义

目的：探讨不同程度低血容量性休克患者动静脉血ｐＨ差［ｐＨ（Ａ－Ｖ）］及ＰＣＯ２差［ＰＣＯ２（Ａ－Ｖ）］的变化及临床意义。方法：观察３５例创伤失血性休克（轻度１５例、中重度２０例）ｐＨ（Ａ－Ｖ）及ＰＣＯ２（Ａ－Ｖ）以及重度休克患者治疗过程中ｐＨ（Ａ－Ｖ）及ＰＣＯ２（Ａ－Ｖ）动态变化及其预后。结果：随休克程度加重，ｐＨ（Ａ－Ｖ）进行性增大；中重度休克ＰＣＯ２（Ａ－Ｖ）显著高于轻度休克和对照患者（Ｐ＜００１），后二者无差别（Ｐ＞００５）；重度休克治疗过程中ｐＨ（Ａ－Ｖ）及ＰＣＯ２（Ａ－Ｖ）持续增大者死亡率高。结论：低血容量性休克ｐＨ（Ａ－Ｖ）及ＰＣＯ２（Ａ－Ｖ）随休克程度加重而增大，重度休克治疗期间ｐＨ（Ａ－Ｖ）及ＰＣＯ２（Ａ－Ｖ）持续增大，提示预后不良。

Changes of Arteriovenous pH,PCO2 Gradients of Patients with Hypovolemic Shock

Objective:To study the changes and clinical significance of arteriovenous pH gradient pH(A-V) and PCO 2 gradient PCO 2(A-V) of patients with hypovolemic shock.Methods:pH(A-V) and PCO 2(A-V) of 35 shocked patients were monitored before anti shock.Dynamic changes of the two indexes and prognosis of patients ( n =18) with hypovolemic shock of severe type were also observed during treatment against shock.Results:pH(A-V) expanded progressively with the extent of shock,PCO 2(A-V) was significantly higher in patients with severe shock than in patients with slight shock and the control.Changes of pH(A-V) and PCO 2(A-V) paralleled tissue hypoxia.8 of 18 patients had persistently expanding pH(A-V) and PCO 2(A-V) during anti shock and had a higher mortality.Conclusion:pH(A-V) and PCO 2(A-V) of patients with hypovolemic shock expand with the extent of shock.Persistently expanding pH(A-V) and PCO 2(A-V) suggest prognosis of the patients is severe.