Application Of Central Venous-arterial Carbon Dioxide Difference Combined With Lactate Clearance Rate In Volume Monitoring Of Septic Shock Patients

Objective:Sepsis is a common clinical critical disease in intensive care unit,which systemic inflammatory response syndrome caused by infection can lead to multiple organ dysfunction.Some patients may even develop into severe sepsis and septic shock.The disease progresses rapidly.It could evolve into multiple organ failure easily and endanger the patients’ lives.Fluid resuscitation is an important method for the treatment of sepsis,which can correct tissue hypoperfusion as soon as possible and reduce organ ischemia and hypoxia.As an addition fluid resuscitation parameter of patients in severe sepsis,Pcv-aCO2 has more obvious advantages compared with traditional indicators of systemic oxygen metabolism.So,this study investigated the prognostic significance of Pcv-aCO2 combined with LCR as early resuscitation goals of sepsis patients,it also provides a basis for the volume index and its effect of patients with severe sepsis and septic shock.Methods:We recruited 68 patients who were diagnosed as sepsis and need for fluid resuscitation in Intensive Care Unit in Binzhou Medical University Hospital from August 2017 to December 2018.When patients were admitted to hospital,they were immediately given active treatments and fluid resuscitation as early as possible according to the early goal-directed therapy in the relevant guidelines.The arterial and central venous blood gases were measured simultaneously at baseline and 6 hours after resuscitations and calculate Pcv-aCO2 and LCR.Patients were classified into four groups according to Pcv-aCO2 and LCR at 6h after fluid resuscitation:group A(Pcv-aCO2>6mmHg and LCR<30%),group B(Pcv-aCO2>6mmHg and LCR≥30%),group C(Pcv-aCO2≤6mmHg and LCR<30%),and group D(Pcv-aCO2≤6mmHg and LCR≥30%).General demographics,physiological indicators,laboratory parameters,the amount of fluid entering the body and the prognosis were compared among the four groups.Results:The general clinical data of patients between the four groups before fluid resuscitation treatment,such as gender,age,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score and sequential organ failure assessment(SOFA)score on the first day after admission to the ICU,and source of the primary infection site,did not change significantly(P>0.05).MAP,HR,CVP,Hb,Scr,ScvO2,Pcv-aCO2,pH,Lac between the four groups before fluid resuscitation did not change significantly(P>0.05).MAP,HR,CVP,Hb,Scr,ScvO2,pH,and the amount of 6h fluid entering the body after fluid resuscitation did not change significantly(P>0.05).Pcv-aCO2,Lac and 6hLCR were significantly different in the four groups(P<0.05).At T6,Pcv-aCO2 had correlation with Lac.At TO and T6,Pcv-aCO2 had correlation with ScvO2.At T6,Pcv-aCO2 had correlation with ScvO2.Conclusions:1.Pcv-aCO2 has a good correlation with ScvO2 and lactate clearance rate.2.The combination of Pcv-aCO2 and lactate clearance rate can assess the condition of patients with septic shock and the prognosis,and could be avoided inadequate fluid resuscitation when the ScvO2 goal was false-normalization,which can be used as the goal of fluid resuscitation in patients with severe sepsis or septic shock.