The Study Of Fluid Resuscitation Therapy On The Treatment Of Severe Sepsis And Sepic Shock Patients

Objective To investigate the efficacy of early goal-directed therapy in the treatment of severe sepsis and septic shock patients.This method of fluid resuscitation took CVP(central venous pressure ),MAP(mean arterial pressure ),SmvO₂(mixed venous oxygen saturateion) as its end points. Methods Slected 20 severe sepsis or septic shock patients,measured their hemodynamics,systemic oxygen metabolism,regional perfusion and vascular endothelial cell function , before and after fluid resuscitation. Results Indexes of hemodynamics after resuscitation:A higher PAWP(l6.20±2.75 vsl0.20±2.39 mmHg),a higher CI (5.91±1.37 vs4.36±1.04 L/min.m²),a higher SVRI(1384.05±485.18 vs 1068.55±407.59 dyne.sec/cm⁵.m²) , a lower PVRI (116.95±62.23 vs 139.85±68.69 dyne.sec/cm⁵.m²) ,a higher LVSWI(50.98±l4.44vs37.07±ll.56g./m.m²),P<0.01 for allcomparisons;but there were no significant differences compared with before resuscitation in RVSWI(l2.03±7.47vsll.65±7.34 g./m.m2) .Indexes of systemic oxygen metabolism after resuscitations higher DO2 (801.85±204.35vs585.93±184.57ml/min.m2,P<0.01 for comparison ),a lower O2ex (27.07±n.7%vs36.l8±l2%, P<0.05 for comparison ),no significant differences were found in VO2 , VO2/ DO2 dependency existed before resuscitation(r=0.32,P<0.0l) ,also after resuscitation(r=0.38,P<0.0l). Indexes of regional perfusion after resuscitation: a lower ABL(5.98±3.90mmol/Lvs7.56±3.14mmol/L,P<0.01 for COmparison),alowerPg-aC02(11.72±6.47mmHg vsl5.49±6.75 mmHg ,P<0.01 for comparison).There was a positive relationship between ABL and Pg-aCO2(r=0.546, P2 decreased significantly(P2 decreased just a little and had no significant defference was found in death group(P>0.05).Indexes of vascular endothelial cell functions lower ETi(51.81±28.08pg/ml vs 71.24±31.95 pg/ml,P<0.05 for comparison), vWF(l75.95±39.33 %vs214.85±40.93% ,P<0.005 for comparison).Conclusion Early goal-directed therapy could improve hemodynamic status,increase oxygen delivery,restore regional perfusion,alleviate the damage of vascular endothelial cell,but whether it could effectively modulate systemicoxygen metabolism was uncertain.To improve outcome of severe sepsis and septic shock patients,it is important to get early diagnosis and early therapy,including fluid resuscitation .