标题：ScvO2和乳酸清除率指导严重感染患者早期液体复苏的效果比较

      作者：王振贤 1，胡少敏 2，陈 钰 2，梁 勇 2，许俊旭 2，郑友锋 2，吴挺实 2，周 森 3
    (1.海口市中医医院重症医学科，海南 海口 570216；
2.海口市第三人民医院呼吸内科，海南 海口 571100；
3.海南省农垦总局医院重症医学科，海南 海口 570311)

      卷次： 2015年26卷15期

      【摘要】 目的 比较检测乳酸清除率和中心静脉血氧饱和度(ScvO2)指导严重感染患者早期液体复苏的效
果。方法 选取2012年1月至2014年12月期间海口市第三人民医院和海南省农垦总局医院重症医学科收治的
30例严重感染或感染性休克患者，随机分为对照组(A组)、ScvO2组(B组)和乳酸清除率组(C组)，每组10例。A组
患者早期液体复苏期间给予常规基本监测，B组患者在A组基础上添加复苏指标ScvO2>70%，C组患者在A组基
础上添加复苏指标乳酸清除率>10%，比较三组患者的治疗效果、治疗前后APACHEⅡ评分、住院时间和 ICU滞
留时间。结果 三组患者多器官功能障碍综合征(MODS)的发生率及 7 d死亡率比较差异均无统计学意义(P>
0.05)；治疗前三组患者的APACHEⅡ评分差异无统计学意义(P>0.05)，治疗后B、C组患者的APACHEⅡ评分均明
显高于A组，差异均有统计学意义(P<0.05)；三组患者的住院时间比较差异无统计学意义，但 ICU滞留时间A组
患者明显长于B、C组，差异均有统计学意义(P<0.05)。结论 ScvO2和乳酸清除率均可用于指导严重感染患者的
早期液体复苏，均可作为预后的重要评估指标。

      【关键词】 中心静脉血氧饱和度；乳酸清除率；液体复苏；严重感染；预后

      【中图分类号】 R63 【文献标识码】 A 【文章编号】 1003—6350（2015）15—2215—03


Effect of central venous oxygen saturation and lactate clearance rate in providing guidance for early fluid
resuscitation of patients with severe infection.
WANG Zhen-xian 1, HU Shao-min 2, CHEN Yu 2, LIANG Yong 2, XU
Jun-xu 2, ZHENG You-feng 2, WU Ting-shi 2, ZHOU Sen 3. 1. Intensive Care Unit (ICU), Traditional Chinese Medicine
Hospital of Haikou City, Haikou 570216, Hainan, CHINA; 2. Respiratory Department, the Third People’s Hospital of
Haikou, Haikou 571100, Hainan, CHINA; 3. ICU, Hainan Provincial Nongken General Hospital, Haikou 570311,
Hainan, CHINA

【Abstract】 Objective To compare the effect of central venous oxygen saturation (ScvO2) and lactate clear-
ance rate in providing guidance for early fluid resuscitation of patients with severe infection. Methods From January
2012 to December 2014, 30 patients with severe infection in the Third People's Hospital of Haikou City and Hainan
Provincial Nongken General Hospital were randomly divided into control group (group A), ScvO2 group (group B)
and lactate clearance rate group (group C), with 10 cases in each group. During the early fluid resuscitation, patients in
group A received conventional basic monitoring, patients in group B additionally took ScvO2 as monitoring index (ScvO2 >
70%) on the basis of group A , and patients in group C additionally took lactate clearance rate as monitoring index (lac-
tate clearance rate>10% ) on the basis of group A. Clinical efficacy, APACHE Ⅱ score before and after treatment,
length of hospital stay, and ICU retention time were compared between the three groups. Results The three groups
showed no statistically significant difference in the incidence of multiple organ dysfunction syndrome (MODS) and
7-d mortality (P>0.05). APACHEⅡ scores before treatment showed no statistically significant difference between the
three groups (P>0.05), and the score after treatment was significantly higher in group B, C than group A (P<0.05). The
length of hospital stay showed no statically significant difference between the three groups, but the ICU retention time
was significantly longer in group A than group B, C (P<0.05). Conclusion ScvO2 and lactate clearance rate both has
great clinical significance in guiding early fluid resuscitation for patients with severe infection, which can both serve
as the important indexes for the evaluating prognosis.

      【Key words】 Central venous oxygen saturation (ScvO2); Lactate clearance rate; Fluid resuscitation; Severe in-
fection; Prognosis