标题：严重脓毒症及脓毒性休克患者SV、ScVO2、乳酸清除率、心肌酶学的相关性研究

      作者：陈矛，姜悦，黄樱菲，江其影，许丽清，谢欢欢
    (广东医学院附属阳江医院广东阳江市人民医院重症医学科，广东 阳江 529500)

      卷次： 2016年27卷4期

      【摘要】 目的 研究严重脓毒症及脓毒性休克患者每搏输出量(SV)、中心静脉血氧饱和度(ScVO2)、乳酸清除
率和心肌酶学的相关性。方法 选择我院2014年1月至2015年6月 ICU严重脓毒症和脓毒性休克患者125例，根
据预后分为两组，其中存活组78例，死亡组47例，比较两组患者入 ICU时的SV、ScVO2、血清乳酸浓度、6 h乳酸清
除率和心肌酶学等指标。结果 存活组与死亡组患者入 ICU时的SV、ScVO2比较差异均无统计学意义(P>0.05)；
存活组患者入 ICU时的血清乳酸浓度为(5.17±1.23) mmol/L，低于死亡组的(5.51±1.33) mmol/L，谷草转氨酶(AST)
为(165.4±23.8) U/L，低于死亡组的(185.2±24.6) U/L，LDH、CK、CK-MB等心肌酶学等指标也均低于死亡组，差异均
有统计学意义(P<0.05)；治疗6 h，存活组患者的SV、ScVO2较入 ICU时有明显提高，血清乳酸浓度明显降低，6 h乳
酸清除率明显高于死亡组，差异均有统计学意义(P<0.05)；两组患者治疗6 h后的心肌酶学等指标与入 ICU时比较
差异均无统计学意义(P>0.05)。结论 严重脓毒症及脓毒性休克患者入 ICU时SV、ScVO2与预后无关，与心肌酶
学有关；入 ICU 6 h SV、ScVO2、乳酸浓度、乳酸清除率与预后密切相关。

      【关键词】 严重脓毒症；脓毒性休克；SV；ScVO2；乳酸清除率；心肌酶学；相关性

      【中图分类号】 R631+.2 【文献标识码】 A 【文章编号】 1003—6350（2016）04—0551—03


Study on SV, ScVO2, lactate clearance and myocardial enzyme in patients with severe sepsis and septic shock.
CHEN Mao, JIANG Yue, HUANG Ying-fei, JIANG Qi-ying, XU Li-qing, XIE Huan-huan.
Severe Medical Science, the
Affiliated Yangjiang Hospital of Guangdong Medical College, the People's Hospital of Yangjiang City, Yangjiang 529500,
Guangdong, CHINA

【Abstract】 Objective To study the correlation beween stroke volume (SV), central venous blood oxygen sat-
uration (ScVO2), lactate clearance rate and myocardial enzymology in patients with severe sepsis and septic shock.
Methods From January 2014 to June 2015, 125 patients with severe sepsis and septic shock in ICU were divided into
two groups according to prognosis: survival group (n=78) and death group (n=47). The SV, ScVO2, serum lactic acid con-
centration, 6 h lactate clearance rate and myocardial enzymology at admission to ICU were compared between the two
groups. Results SV, ScVO2 at admission to ICU showed no statistically significant difference between the two groups
(P>0.05). The serum lactic acid concentration, aspartate aminotransferase (AST) in the survival group were significantly
lower than those in the death group [(5.17±1.23) mmol/L vs (5.51±1.33) mmol/L, (165.4±23.8) U/L vs (185.2±24.6) U/L],
and myocardial enzymology indexes (LDH, CK, CK-MB) in the survival group were also significantly lower. The differ-
ences were all statistically significant (P<0.05). After treatment of 6 h, SV and ScVO2 in the survival group increased sig-
nificantly compared with those at admission to ICU, with serum lactic acid concentration decreased significantly, and 6 h
lactate clearance rate was significantly higher than that in the death group (P<0.05). The myocardial enzymology index-
es of the two groups after treatment for 6 h showed no statistically significant difference with those at admission to ICU
(P>0.05). Conclusion For patients with severe sepsis and septic shock, the SV, ScVO2 at admission to ICU has noth-
ing to do with the prognosis, but are related to myocardial enzymology. The SV, ScVO2, lactic acid concentration, lactate
clearance rate 6 h after admission to ICU are closely related to the prognosis.

      【Key words】 Severe sepsis; Septic shock; Stroke volume (SV); Central venous blood oxygen saturation (ScVO2);
Lactate clearance rate; Myocardial enzymology; Correlation
·论 著·
6350.2016.04.011