中心静脉动脉CO2分压差联合SOFA评分对开腹结肠癌术后液体复苏的指导作用
Observation of postoperative fluid resuscitation of Pcv-aCO2 combined with SOFA in open surgery of colon cancer

胡述立.中心静脉动脉CO2分压差联合SOFA评分对开腹结肠癌术后液体复苏的指导作用[J].内科急危重症杂志,2019,25(1):21-23

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DOI：10.11768/nkjwzzzz20190106

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作者	单位	E-mail
胡述立	武汉市第一医院	18963980692@126.com

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中文摘要:

目的:观察全麻开腹结肠癌术后患者复苏前后SOFA评分的变化与Pcv-aCO2相关性。方法：选取行全麻剖腹探查+结肠癌根治术患者72例，在液体复苏开始时及液体复苏24h后，均进行序贯器官衰竭评分（SOFA评分），计算ΔSOFA，并根据ΔSOFA评分分为ΔSOFA≤3分组与ΔSOFA＞3分组，比较2组患者中心静脉CO2分压差（Pcv-aCO2）、平均动脉压（MAP）、中心静脉压（CVP）、中心静脉血氧饱和度（ScvO2）、乳酸清除率等的统计学差异及与ΔSOFA的相关性。结果：乳酸清除率（P=0.001，R =0.927）、Pcv-aCO2（P=0.03，R=0.811）与ΔSOFA显著相关（P<0.05）；MAP（P=0.580，R=0.236）、CVP（P=0.288，R=0.334）、ScvO2（P=0.209，R =0.305）、CI（P=0.190，R=0.312）与ΔSOFA无显著相关(P>0.05)。结论：Pcv-aCO2可指导开腹结肠癌术后患者进行液体复苏的容量管理，当ScvO2达到70%时，其对氧供需关系的预测仍然敏感。

英文摘要:

Objective: To investigate the sequential organ failure assessment (SOFA) scores before and after open colon surgery of colon cancer under general anesthesia and their correlation with Pcv-aCO2. Methods: A total of 72 patients in the First Hospital of Wuhan from September 2015 to November 2016 were enrolled in this study. The patients underwent the radical resection of colon cancer under the general anesthesia. At the beginning of the fluid resuscitation and 24 h after fluid resuscitation, the SOFA score was recorded and ΔSOFA score was calculated. According to the ΔSOFA score, the patients were divided into ΔSOFA score≤3 and ΔSOFA>3 groups. The differences of Pcv-aCO2, MAP, CVP, ScvO2 and lactic acid clearance were compared between the two groups before and 24h after resuscitation, and their correlation with ΔSOFA was analyzed. Results Lactate clearance (P=0.001, R=0.927) and Pcv-aCO2 (P=0.03, R=0.811) were significantly associated with ΔSOFA (P<0.05). MAP (P=0.580, R=0.236), CVP (P=0.288, R=0.334), ScvO2 (P=0.209, R=0.305) and CI (P=0.190, R=0.312) were not significantly correlated with ΔSOFA (P>0.05). Conclusion: Pcv-aCO2 can be used as an indicator to guide the volume management of patients undergoing open surgery for colon cancer. Especially when ScvO2 reached 70%, Pcv-aCO2 is still sensitive in predicting the oxygen supply and demand.