中国典型病例大全

目的 深入探究中心静脉血氧饱和度(central venous oxygen saturation,ScvO₂)与外周灌注指数(periphery perfusion index,PPI)联合监测用于脓毒性休克患者液体复苏进程中的效果。方法 选取2022年1月—2024年12月徐州市贾汪区人民医院收治的64例脓毒性休克患者为研究对象，将其随机分为对照组(n=32)与观察组(n=32)。对照组施行传统液体复苏策略，而观察组则于ScvO₂监测基础上，融合PPI以指导液体复苏。对比两组患者复苏前及复苏6 h后的ScvO₂、PPI、平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)、血乳酸(blood lactate,Lac)水平以及预后。结果 复苏前，两组ScvO₂、PPI、MAP、CVP比较，无统计学差异(P>0.05)；复苏6 h后，观察组ScvO₂、PPI、MAP、CVP略高于对照组，但无统计学差异(P>0.05)。复苏前两组的Lac水平比较，无统计学差异(P>0.05)；复苏6 h后，观察组Lac水平则略低于对照组，但无统计学差异(P>0.05)。观察组的机械通气时长、ICU住院时长以及28 d病死率均低于对照组(P<0.05)。结论 ScvO₂联合PPI监测对改善脓毒性休克患者的预后有一定帮助，可降低患者病死率，具备重要的临床应用价值。

Objective Aims to deeply explore the clinical efficacy of the combined monitoring of central venous oxygen saturation(ScvO₂) and peripheral perfusion index(PPI) in the process of fluid resuscitation for patients with septic shock. Methods A total of 64 patients with septic shock were selected from January 2022 to December 2024 in Jiawang District People's Hospital of Xuzhou City and randomly divided into a control group(n=32)and an observation group(n=32). The control group adopted the traditional fluid resuscitation strategy, while the observation group integrated PPI on the basis of ScvO₂ monitoring to guide fluid resuscitation. Statistical data analysis was carried out on the levels of ScvO₂, PPI, mean arterial pressure(MAP), central venous pressure(CVP), blood lactate(Lac)and prognosis-related indicators of the two groups of patients before resuscitation and 6 hours after resuscitation. Results Before resuscitation, there were no significant differences in the values of ScvO₂, PPI, MAP and CVP between the observation group and the control group(P>0.05). Six hours after resuscitation, the above-mentioned indicators measured in the observation group were slightly higher than those in the control group, but the differences between the two groups were not statistically significant(P>0.05). There was no significant difference in the level of Lac between the two groups before resuscitation(P>0.05). Six hours after resuscitation, the level of Lac in this group was slightly lower than that in the control group, and the difference was not statistically significant(P>0.05). The duration of mechanical ventilation, the length of stay in the ICU and the 28-day mortality rate of the observation group were all lower than those of the control group(P<0.05). Conclusion Monitoring of ScvO₂ combined with PPI is helpful to improve the prognosis of patients with septic shock, can reduce the mortality rate of patients, and has important clinical application value.