Analysis And Clinical Significance Of Changes In Hemodynamic Indicators After Early Fluid Resuscitation In Septic Shock

Part 1 The Relationship between Pcv-aCO₂ combined with ScvO₂ and other hemody-namic parameters on early fluid resuscitation in septic shock patients.Objective:To observe the relationship between Pcv-aCO₂ combined with ScvO₂ and other hemodynamic parameters on early fluid resuscitation in sepsis patients.Methods:There were Twenty-four septic shock patients admitted to Department of Critical Care Medicine of Linyi central Hospital from December 2017 to December 2018 in this study.All patients received an initial resuscitation therapy according to early goal directed therapy.The patients were divided into two groups,With Pcv-aCO₂<6mmHg as group A and Pcv-aCO₂?6mmHg as group B.The general data,hemodynamics,lactate clearance rate?LCR?,APACHEII,SOFA,mechanical ventilation time,ICU hospitalization days and 28-day mortality were observed baseline and 6 hours after resuscitation.Results:The hemodynamic of the two groups 6 hours after resuscitation were significantly different from baseline resuscitation?P<0.05?,but there was no significant difference in hemodynamics between the two groups.compared with B group The duration of ICU stay and mechanical ventilation of group A was decreased and lactate clearance rate of group A was increased significantly?P<0.05?.Conclusion:Pcv-aCO₂<6mmHg as the resuscitation goals in sepsis and sepsis shock patients make up for the deficiency of ScvO₂?70%as the end point of resuscitation to avoid premature termination of resuscitation,and improve tissue hypoperfusion.Part 2 The Significance the Prognosis of Pcv-aCO₂ combined with ScvO₂ on early fluid resuscitation in sepsis patients.Objective To observe the significance the Prognosis of Pcv-aCO₂ combined with ScvO₂on early fluid resuscitation in septic shock..Methods There were Forty-four septic shock patients admitted to Department of Critical Care Medicine of Linyi central Hospital from December 2017 to December 2018 in this study.All patients received an initial resuscitation therapy.The patients were divided into four groups,With Pcv-aCO₂<6mmHg and ScvO₂?70%as group1,Pcv-aCO₂?6mmHg and ScvO₂?70%as group 2,With Pcv-aCO₂<6mmHg and ScvO₂<70%as group3and Pcv-aCO₂?6mmHg and ScvO₂<70%as group 4.The general data,hemodynamics,lactate clearance rate?LCR?,mechanical ventilation time,ICU hospitalization days and28-day mortality were observed baseline and 6 hours after resuscitation.The ROC curve of ScvO₂,Pcv-aCO₂ and their combined indicators were 0.542,0.786 and 0.908 respectively.The combined indicators of ScvO₂ and Pcv-aCO₂ were better than ScvO₂ and Pcv-aCO₂alone in predicting prognosis?P<0.05?.Results The hemodynamic of the two groups 6 hours after resuscitation were significantly different from baseline resuscitation?P<0.05?,but there was no significant difference in hemodynamics between the Four groups compared with other groups.The duration of ICU stay and mechanical ventilation of group 1 was decreased and lactate clearance rate of group 1 was increased significantly?P<0.05?.And there was significant difference in 28-day mortality between the Four groupsConclusion Pcv-aCO₂ combined with ScvO₂ has significance for the prognosis of septic shock.