Effects Of Venous-arterial Partial Pressure Difference Of Carbon Dioxide Combined With Central Venous Oxygen Saturation In The Fluid Resuscitation Of Traumatic Shock

Objective:To investigate the effects of venous-arterial partial pressure difference of carbon dioxide?PcvaCO₂?combined with central venous oxygen saturation?Scv0₂?in the fluid resuscitation of traumatic shock.Methods:106 patients with traumatic shock in department of critical care medicine of Central Hebei Energy Xingtai Mining Group General Hospital were collected for the study according to the relevant diagnosis,inclusion and exclusion criteria,and they were divided into Scv0₂ target group[center venous pressure?CVP?control of 8 mmHg?12mmHg during mechanical ventilation?,mean arterial pressure?MAP??65mmHg,urine volume?0.5mL/kg·h,Scv0₂>70%,treated for 6 h at maintaining above levels after the indicators met the standards]and Scv0₂+PcvaCO₂ target group[after successful volume resuscitation?ie,reaching resuscitation standard in Scv0₂target group?,PcvaCO₂?6mmHg suggested volume adjustment in titrated way to ensure that PcvaCO₂<6 mmHg was maintained at this level for 6 h of treatment]according to the random number table method,with 53 cases in each group.Mechanical ventilation time,28d mortality rate and ICU stay were compared between the two groups.Heart rate,respiration,CVP,urine volume,cardiac output index?CI?and mean arterial pressure?MAP?were monitored by the Bioilght Q5 ECG monitor before resuscitation and at 6 h after resuscitation,and Siemens RAPID Point500 blood gas analyzer was used to analyze the lactate value and lactate clearance rate at 6 h and 24 h and arterial blood gas indexes[arterial partial pressure of oxygen?PaO₂?,oxygenation index?PaO₂/FiO₂?,arterial partial pressure of carbon dioxide?PaCO₂?,arterial oxygen saturation?SaO₂?]and center venous blood gas indexes[pH,partial pressure of blood oxygen?PcvO₂?,blood oxygen saturation?ScvO₂?,venous blood oxygen content?CcvO₂?].The 6h fluid balance volume and drug dosage,Acute Physiology and Chronic Health?APACHE II score?and incidence rate of adverse reactions and 24h SOFA score were compared between the two groups.Results:There were no significant differences in the heart rate,respiration,urine volume,CI,CVP,MAP,PaO₂/FiO₂,PaCO₂,SaO₂,pH value,PcvO₂,ScvO₂,PcvCO₂,lactate value and lactate clearance rate and APACHE II scores between Scv0₂ target group and Scv0₂+PcvaCO₂ target group before resuscitation?P>0.05?.The heart rate,respiration,PaCO₂ and PcvCO₂ were decreased significantly compared with those before resuscitation while the urine volume,CI,CVP,MAP,PaO₂/FiO₂,SaO₂,pH value,PcvO₂ and ScvO₂were increased significantly.After resuscitation,the heart rate,respiration,PaCO₂ and PcvCO₂ in Scv0₂+PcvaCO₂ target group were significantly lower than those in Scv0₂ target group while the urine volume,CI,CVP,MAP,PaO₂/FiO₂,SaO₂,pH value,PcvO₂ and ScvO₂ in Scv0₂+PcvaCO₂ target group were significantly higher than those in Scv0₂ target group?P<0.05?.The lactate value and APACHEII score in Scv0₂+PcvaCO₂ target group were significantly lower than those in Scv0₂ target group at 6 h and 24 h after resuscitation while the lactate clearance rate was significantly higher than that in Scv0₂ target group,and norepinephrine dosage and dobutamine dosage in Scv0₂+PcvaCO₂ target group were significantly lower than those in Scv0₂target group and the 6h fluid balance volume were significantly higher than those in Scv0₂ target group,?P<0.05?.The mechanical ventilation time and ICU stay in Scv0₂+PcvaCO₂ target group were significantly shorter than those in Scv0₂ target group?P<0.05?,but there was no significant difference in the28d mortality rate compared with that in Scv0₂ target group?9.43%vs13.20%??P>0.05?.In addition,the total incidence rate of adverse reactions in Scv0₂+PcvaCO₂ target group was lower than that in Scv0₂ target group?16.98%vs13.21%??P>0.05?.There was no significant difference in 24h SOFA score between the two groups?P>0.05?.Conclusions:Scv0₂ combined with PcvaCO₂ as target fluid resuscitation has a clear clinical application value in the treatment of patients with traumatic shock.And it has positive effects on stabilizing vital signs of patients and improving hemodynamics,arteriovenous blood gas,tissue oxygen metabolism and prognosis.What's more,it is expected to be a safe and effective treatment regimen for patients with traumatic shock to save life.