| Objective By observing patients with septic shock admitted to the intensive care unit（ICU）during early fluid resuscitation,the central vein-arterial carbon dioxide partial pressure difference（Pcv-a CO2,GAP）and ultrasound were used as indicators to guide fluid resuscitation,respectively.Pcv-a CO2（GAP）and ultrasound were used as indicators to guide fluid resuscitation and to observe and compare the therapeutic effects in order to provide treatment options for more patients.Methods From October 2021 to December 2022,41 patients who met the diagnostic criteria of septic shock and were seen in the Department of Comprehensive Intensive Care Medicine of Baotou Central Hospital were selected.Patients were monitored for changes in kinetics and fluid resuscitation.The heart rate,central venous oxygen saturation,blood pressure,respiratory rate,blood gas analysis（partial pressure of oxygen）,lactate,renal function（Cr）,BNP indexes at T1,T2 and T3,urine output and fluid resuscitation dosage at T2 and T3 were recorded at 0h（T1）,24h（T2）and resuscitation attainment（T3）after rehydration treatment.The goal of resuscitation in the central venous-arterial carbon dioxide partial pressure difference group was Pcv-a CO2<6 mm Hg;in the ultrasound group,the inferior vena cava diameter（IVCD）was measured and the goal of resuscitation was IVCDmin≥1 cm in spontaneously breathing patients and IVCDmin≥1.5 cm in mechanically ventilated patients[1].Also patients in both groups were required to meet the 2012 early resuscitation goals for severe sepsis:central venous pressure 8-12 mm Hg;mean arterial pressure≥65 mm Hg;central venous oxygen saturation≥70%;urine output≥0.5 ml/kg/h.To compare the amount of fluid resuscitation,vital signs（heart rate,blood pressure,oxygen saturation,respiratory count）and renal function（Cr）before and after resuscitation in both groups,the blood gas analysis（partial pressure of oxygen）,lactate,BNP changes,and the incidence of adverse events such as pulmonary edema during resuscitation.Results（1）Forty-one patients were finally included in the case study,including 20 cases in the ultrasound group and 21 cases in the central venous-arterial carbon dioxide partial Pressure difference group.（2）The incidence of pulmonary tissue and other important organ edema was 10.0%and 14.3%in the ultrasound group and central venous-arterial carbon dioxide partial pressure difference,res Pectively,and the difference between the two groups was not statistically significant（P>0.05）.（3）There was no statistically significant difference in heart rate between the two groups at T1,T2 and T3moments（P>0.05）,and both were T1>T2>T3.There was no statistically significant difference in diastolic and systolic blood pressure between the two groups at T1,T2 and T3 moments（P>0.05）,and the comparison of time within the groups was statistic ally significant（P<0.05）,and diastolic and systolic blood pressure in both groups were T3>T2>BNP was not statistically significant at TI,T2,and T3 moments（P>0.05）,and the intra-group time variation was statistically significant（P<0.05）,and T1<T2<T3 moments in both groups.cr was not statistically significant at T1,T2,and T3 moments（P>0.05）,and the intra-group time variation was statistically significant（P<0.05）,where ultrasound group and central venous-arterial carbon dioxide partial pressure difference group were T3<T2<T1 moments（P<0.05）.The amount of fluid resuscitation in both groups was statistically significant at the T2 and T3 moments（P<0.05）,and at the T2 and T3 moments,it was greater in the ultrasound group than in the central venous-arterial carbon dioxide partial pressure difference group.Conclusion During fluid resuscitation for septic shock in the intensive care unit,both ultrasound and central venous-arterial partial pressure difference of carbon dioxide can guide fluid resuscitation,and the more effective and safer of the two is central venous-arterial partial pressure difference of carbon dioxide. |
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