中心静脉-动脉血二氧化碳分压差在重症胰腺炎液体复苏中的意义

【目的】探讨中心静脉-动脉二氧化碳分压差（Pcv-aCO2）在重症急性胰腺炎（SAP）急性期液体复苏治疗患者中心静脉血氧饱和度（ScvO2）＞70％情况下，进一步液体复苏评价的临床意义。【方法】选择2013年2～10月间47例入住 ICU病房经早期液体复苏，ScvO2＞70％的 SAP患者。根据患者入组时（T1）的 Pcv-aCO2的值，以6 mmHg为界，分为低Pcv-aCO2组（A组，24例）和高Pcv-aCO2组（B组，23例）。复苏治疗12 h（T2）后再进行一次测量。【结果】T1时 A组患者的乳酸（LA）与 B组患者（3．35±0．49）mmol/L vs（4．46±1．18）mmol/L差异有统计学意义（P＜0．01），但ScvO2值（72．92±2．21）％ vs（74．43±3．94）％差异无统计学意义（P＞0．05）。T1到T2时段A组的乳酸清除率（LAC）大于B组（P＜0．01）。T1、T2时段的Pcv-aCO2值和LA呈直线相关（r＝0．523、0．537，均P＜0．01），与LAC也存在良好的负相关（r＝-0．49、0．54，均P＜0．01）。【结论】SAP进行液体复苏的患者，ScvO270％目标值虽已达标，但仍可能存在组织灌注不足。Pcv-aCO2＞6 mmHg 可以作为早期液体复苏后 ScvO2达标的 SAP患者进一步液体复苏的指标。

Significance of Central Vein-arterial Partial Pressure Difference of Carbon Dioxide in Fluid Resus-citation for Severe Acute Pancreatitis

[Obj ective]To explore clinical significance of central vein-arterial partial pressure difference of carbon di-oxide（Pcv-aCO2 ）in the assessment of further fluid resuscitation for severe acute pancreatitis（SAP）patients with central venous oxygen saturation（ScvO2 ）＆gt;70% who receive fluid resuscitation at acute phase.[Methods]Totally 47 SAP pa-tients with ScvO2＆gt;70% who received early fluid resuscitation in ICU from Feb.2013 to Oct.2013 were chosen.Ac-cording to Pcv-aCO2 with the threshold of 6mmHg at grouping（T1 ）,all patients were divided into low Pcv-aCO2 group （group A,n=24）and high Pcv-aCO2 group（group B,n=23）.Pcv-aCO2 at 12h after resuscitation（T2 ）was measured again.[Results]There was significant difference in lactic acid（LA）between group A and group B at T1 [（3.35±0.49 mmol/L）vs.（4.46±1.18）mmol/L]（P〈0.01）,but there was no significant difference in ScvO2 between two groups [（72.92±2.21）% vs.（74.43±3.94）%]（P〉0.05）.The clearance of lactate acid（LAC）in group A from T1 to T2 was higher than that in group B（P〈0.01）.Pcv-aCO2 at T1 and T2 had linear correlation with LA（r=0.523,0.537, all P〈0.01）,and good negative correlation with LAC（r=-0.49,0.54,all P〈0.01）.[Conclusion]Although the target value of ScvO2 70% is up to the standard,SAP patients receiving fluid resuscitation have insufficient tissue perfu-sion.Pcv-aCO2＆gt;6mmHg can be used as the index of further fluid resuscitation of SAP patients with standard ScvO2 after early resuscitation.