TcPO_2作为监测失血性休克患者早期液体复苏指标的临床意义

目的探讨经皮血氧分压(TcPO2)作为指导失血性休克患者液体复苏早期敏感性指标的意义。方法选取2013年1月至2014年1月江门市五邑中医院恩平分院进行血流动力学早期目标指导治疗(EGDT)的失血性休克患者62例,按其达标情况分为复苏达标组(34例)和复苏未达标组(28例),记录两组患者的急性生理学和慢性健康评估Ⅲ(APACHEⅢ)评分、血氧饱和度(SVO2)、右房压(RAP)和经皮血氧分压(TcPO2),明确TcPO2变化率与复苏达标值之间的关系。结果达标组复苏后的APACHEⅢ评分、RAP、SVO2分别为(17.25±5.84)、(13.13±4.23)mmHg、(76.58±8.84)%,明显优于未达标组的(23.42±4.67)、(9.28±3.33)mmHg、(62.31±5.65)%,差异有统计学意义(P0.05)。在复苏过程中,达标组的TcPO2变化率为(35.85±8.76)%,明显高于未达标组的(11.70±2.84)%,差异有统计学意义(P0.01)。Person相关因素分析表明,复苏达标组的复苏前后的TcPO2变化率与复苏后APACHEⅢ评分、RAP、SVO2呈显著相关(r=-0.378,0.411,0.642,P0.05)。结论在失血性休克患者救治中,TcPO2变化率是评价早期复苏疗效的敏感性指标,可作为失血性休克患者EGDT液体复苏中的达标管理指标。

Significance of arterial blood oxygen partial pressure in patients with hemorrhagic shock during early goal-directed therapy

Objective To dicuss thesignificance of percutaneousoxygen partial pressure in patients with hemorrhagic shock during early goal-directed therapy.Methods 62 cases of patients with uncontrolled hemorrhagic shock during early goal- directed therapy（EGDT） were selected from January 2013 to January 2014. These patientswere divided into two groups： achieving resuscitation target group （34 cases） and non-achieving resuscitation target group （28 cases）. APACHE Ⅲ score, mixed venous oxygen saturation （SVO2）, the right pressure （RAP） and arterial blood oxygen partial pressure （TcPO2） were recorded. The relationship between TcPO2 rate and the recovery of values was analyzed. Results After EGDT, the APACHE Ⅲ score, RAP, SVO2 in achieving resuscitation target group were （17.25±5.84）, （13.13±4.23） mmHg, （76.58±8.84）%, respectively, and were significantly better than those in non-achieving resuscitation target group （23.42±4.67）, （9.28±3.33）mmHg, （62.31±5.65）% ;P〈0.05）]. In the process of recovery,TcPO2 rate in achieving resuscitation target group （35.85±8.76）% ] was significantly higher than that of the non-achieving resuscitation target group （11.70±2.84）%, P〈0.01 ）]. Moreover, person related factors analysis showed that there was a significant correlation between the TcPO2 rate and the APACHE Ⅲ score, RAP, SVO2 inachieving resuscitation target group（r=-0.378, 0.411, 0.642,P〈0.05）. Conclusion In patients with hemorrhagic shock during early goal-directed therapy, percutaneous blood pressure change rate is a sensitive index for evaluating the effect of early recovery, and can be used as a standard management of patients with uncontrolled hemorrhagic shock EGDT liquid recovery index.