| Purpose:During sepsis and septic shock patients fluid resuscitation in ICU, although Scv O2(cardiac venous oxygen saturation) is greater than 70%reaching target of EGDT, there is also adequate evidence indicating the imbalance of oxygen supply and consumption and hemodynamic abnormity,which needs vascular active pharmaceutical. Of the fluid resuscitation in septic shock patients, Pcv-a CO2(venous-arterial carbon dioxide partial pressure difference) is an important parameter. NT-pro BNP(NT-pro brain natriuretic peptide BNP) has been seen as an common sign of cardiac insufficiency, it is elevated in the patients of sepsis and septic shock, part of them have been found cardiac insufficiency and myocardial damage.Pathogenesis of sepsis is complicated. And more studies shows both are closely related to septicopyemia. Whether the serum NT-pro BNP level variation can guide fluid resuscitation is unknown. This paper is to study whether combination application of Pcv-a CO2 and NT-pro BNP will work in guiding fluid resuscitation in patients with sepsis and septic shock.Methods:The study targeted at 60 sereve sepsis and septic shock patients admitted to the Second Intensive Care Unit in the Central Part of No.1Hospital of Shijiazhuang city. The period involved since the 1st February 2014 to 31 December 2014. All patients are offered symptomatically active fluid resuscitation according to guidelines of treatment to severe sepsis and septic shock. All records, including general conditions, clinical features and immediate index before fluid resuscitation, significant physical signs and lab test indexes 6 hour and 24 hour after fluid resuscitation were collected when admitted to ICU. Blood from venous were collected at the beginning fluid resuscitation(T0) and at 6 hour(T6) and 24 hour(T24) resuscitation forrecording NT-pro BNP, and the arterial blood gas and central venous blood gas were collected at the same time. Pcv-a CO2 and response evaluation of tissue perfusion index correlation was analyzed. According to whether finished the resuscitation target after 6h EGDT, the patients divided into two groups:EGDT reched group and EGDT non-reached group. Both the two groups were measured Pcv-a CO2 and NT-pro BNP value. Compare important vital signs,reflecting the oxygen supply and consumption and laboratory parameters of tissue perfusion, the lactate clearance at EGDT 6h and 24 h,changes in 24 h fluid intake in the two groups. Using correlation analysis method to determine whether there is a correlation among Pcv-a CO2, NT-pro BNP and local tissue perfusion index.All the experimental data were analyzed by using the Statistical Package for Social Sciences 19.0(SPSS 19.0, Chicago, IL, USA). The continuous variables were expressed as mean ± standard deviation and analyzed with t test and covariance analysis. Instead of the normal distribution of variables was used Mann-Whitney U test and Kruskal-Wallis ANOVA statistics(α =0.05). P<0.05 was statistically significant difference. Origin 8.0 software package were used to make statistical graphs.Results:1 Patients general clinical dataAccording to the inclusion criteria, a collection of clinical data in severe sepsis and septic shock patients, 60 patients with a mean age(66 ± 10) years old, the oldest was 87 and the youngest was 44 years old, male 55cases(91.7%) and 5 females(8.3%). APACHEⅡaverage score was 18.4 ± 4.9,SOFA score was an average of 4.9 ± 2.1. Of the 60 patients, there are 56males(93.3%) and 4 females(6.7%);There were 57 cases of severe pneumonia(95%) and 3 abdominal infection cases(5%).All the patients were with mechanical ventilation therapy. The average mechanical ventilation days were 15 ± 5 d. The average hospitalization days were 31 ± 12 d. The average ICU length stay was 20 ± 5 d. The death is 18 cases after 28 d, and 28 d mortality rate was 30%.2 The physiological and laboratory parameters in patients with fluid resuscitation.Compared with T0, at T6 and T24 after patients with fluid resuscitation,heart rate(HR), Vein-arterial carbon dioxide partial pressure(Pcv-a CO2), base excess(BE), plasma lactate concentration(LAC), serum creatinine(Scr)concentration were significantly lower(P<0.05), while the central venous pressure(CVP), cardiac venous oxygen saturation(Scv O2), blood PH,addition, the patient’s NT-pro brain natriuretic peptide BNP(NT-pro BNP),mean arterial pressure(MAP) and hemoglobin(HB) did not change significantly(P> 0.05).3 The correlation analysis between Pcv-a CO2, local tissue perfusion index and the fluid intake after 24hPcv-a CO2, Scv O2, lactate clearance rate and the fluid intake after 24 h were analyzed. Analysis results suggest that there is a correlation among Pcv-a CO2, lactate clearance and Scv O2 at T0,T6 and T24. The correlation results between Pcv-a CO2 and Scv O2 is: T0, r =-0.776, P<0.001; T6, r =-0.789, P <0.001; T24, r =-0.885, P<0.001.Correlation analysis between Pcv-a CO2 and lactate clearance: T6, r =-0.365, P = 0.019. T24, r =-0.716, P<0.001.Correlation analysis between Pcv-a CO2 and the fluid intake after 24h: T6,r = 0.452, P = 0.008. T24, r=0.750,P<0.001.4 The correlation analysis between serum NT-pro BNP and local tissue perfusion indexThe serum NT-pro BNP and Scv O2, lactate clearance rate correlation were analyzed. The results suggest that there is no correlation among serum NT-pro BNP, Scv O2 and lactate clearance at T0, T6 and T24(P>0.05).5 The general situation comparison between EGDT reached group and non-reached groupThe 60 patients with septic shock or severe sepsis after fluid resuscitation6 h were divided into two groups(40 cases in EGDT reached group 20 cases in EGDT non-reached group). The age, APACHE Ⅱ score, SOFA score and thesource of the infection were not found statistically difference(P>0.05).6 The comparison between EGDT reached group and EGDT non-reached group after fluid resuscitationThe MAP, HR, CVP, HB, Scr, BE, PH, Pa O2/Fi O2 were not found statistically different at T0(P>0.05) in the two groups. The NT-pro BNP, LAC and Pcv-a CO2 in EGDT reached group were significantly lower than that in EGDT non-reached group. While Scv O2 in EGDT reached group was significantly higher than that in EGDT non-reached group.7 The comparison between EGDT reached group and EGDT non-reached group after fluid resuscitation at 6h and 24hAt T6 and T24 in the two groups, MAP, HR, HB, Scr, BE, PH, Pa O2 /Fi O2 were not statistically different(P>0.05). At T6 and T24, Scv O2 and lactate clearance rate in the EGDT reached group were significantly higher than that in EGDT non-reached group(P<0.05). NT-pro BNP, Pcv-a CO2 and LAC in the EGDT reached group were significantly lower than that in EGDT non-reached group(P<0.05). Meanwhile, the fluid intake after 24 h in the EGDT reached group was significantly lower than that in EGDT non-reached group(P<0.05).8 The prognosis between EGDT reached group and EGDT non-reached groupAfter the two groups of patients after fluid resuscitation, mechanical ventilation days and ICU stay days in the EGDT reached group were significantly lower than that in EGDT none reached group(P<0.05). The28-day mortality and ICU mortality in the EGDT reached group were significantly lower than that in EGDT none reached group(P<0.05). The NT-pro BNP level was greater than 800 pg/ml in the patients(n=18) who died and higher than that of the survivors(n=42).Conclusions:1 There are correlations between Pcv-a CO2 and resuscitation in sepsis and septic shock. In the patients with severe sepsis and septic shock,Pcv-a CO2 is a useful parameter in guiding fluid resuscitation. The higher thePcv-a CO2 is, the more the fluid needs.2 NT-pro BNP does not change significantly in patients with severe sepsis or septic shock after fluid resuscitation. There is no correlation between NT-pro BNP and resuscitation. NT-pro BNP can no guide fluid resuscitation in patients with severe sepsis and septic shock.3 NT-pro BNP may act as an independent risk factor in the prognosis of patients with sepsis and septic shock. The higher the value is, the worse the prognosis will be. |
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