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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(P<0.05)。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(P<0.01)。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,P<0.05)。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。
Objective To investigate the significance of transcutaneous partial pressure of oxygen (TcPO2) as an early indicator of sensitivity to fluid resuscitation in patients with hemorrhagic shock. Methods From January 2013 to January 2014, 62 patients with hemorrhagic shock who underwent early target therapy of hemodynamics (EGDT) were enrolled in Enping Branch of Wuyi Hospital of Traditional Chinese Medicine from January 2013 to January 2014. According to their compliance, 34 cases) and non-compliance group (28 cases) .Acute physiology and chronic health assessment Ⅲ (APACHEⅢ) score, oxygen saturation (SVO2), right atrial pressure (RAP) Pressure (TcPO2), clear TcPO2 rate of change and the relationship between the resumption of compliance values. Results APACHEⅢ, RAP and SVO2 after the resuscitation in the standard group were (17.25 ± 5.84), (13.13 ± 4.23) mmHg, (76.58 ± 8.84)%, which were significantly better than those in the non-compliance group (23.42 ± 4.67, 9.28 ± 3.33) mmHg, (62.31 ± 5.65)%, the difference was statistically significant (P <0.05). During the recovery process, the change rate of TcPO2 in the standard group was (35.85 ± 8.76)%, which was significantly higher than that in the non-standard group (11.70 ± 2.84)%, the difference was statistically significant (P <0.01). Correlation analysis of Person showed that the rate of change of TcPO2 before and after resuscitation of the compliance group was significantly correlated with APACHE Ⅲ score, RAP and SVO2 after resuscitation (r = -0.378,0.411,0.642, P <0.05). Conclusion In the treatment of patients with hemorrhagic shock, the change rate of TcPO2 is a sensitive index to evaluate the efficacy of early resuscitation and can be used as a standard management index for EGDT fluid resuscitation in patients with hemorrhagic shock.