探究中心静脉-动脉血二氧化碳分压差与动脉-中心静脉血氧含量差比值（Pcv-aCO₂/Ca-cvO₂）及乳酸清除率（LCR）在创伤性休克患者液体复苏中的应用价值。

选取2022年4月至2024年4月收治的100例创伤性休克患者，按照单盲区组随机数字表法分为试验组与对照组，每组各50例。对照组患者实施无创超声心输出量监测液体复苏，试验组患者在对照组基础上联合Pcv-aCO₂/Ca-cvO₂及LCR监测液体复苏。比较两组患者的临床指标、急性病生理学和长期健康评价（APACHE）Ⅱ评分、序贯器官衰竭估计（SOFA）评分、格拉斯哥昏迷量表（GCS）评分、血流动力学指标、并发症及28 d病死率。同时，采用Kaplan-Meier生存曲线对两组患者的生存情况进行比较。

相较于对照组，试验组患者6、48 h补液量及48 h血管活性药物用量均更少，机械通气时间、ICU住院时间及总住院时间均更短（P均< 0.05）。两组患者复苏前后APACHE Ⅱ评分（F = 5.594，P = 0.020）、SOFA评分（F = 4.631，P = 0.034）、GCS评分（F = 460.414，P < 0.001）、平均动脉压（MAP）（F = 12.064，P < 0.001）、心率（F = 4.233，P = 0.040）、中心静脉血氧饱和度（ScvO₂）（F = 7.541，P = 0.008）的比较差异均有统计学意义；相较于复苏前，复苏后6、24 h两组患者APACHEⅡ评分、SOFA评分、心率均显著降低，GCS评分、MAP、ScvO₂均显著升高（P均< 0.05）；且试验组APACHEⅡ评分、SOFA评分、GCS评分、MAP、心率、ScvO₂均优于对照组（P均< 0.05）。试验组患者并发症发生率[6%（3/50）vs. 20%（10/50），χ² = 4.332，P = 0.037]及28 d病死率[10%（5/50）vs. 26%（13/50），χ² = 4.336，P = 0.037]较对照组均更低。Kaplan-Meier生存曲线显示，试验组患者的生存曲线显著优于对照组（χ² = 3.900，P = 0.048）。

Pcv-aCO₂/Ca-cvO₂及LCR应用于创伤性休克液体复苏中具有较好的临床效果，可有效稳定血流动力学、促进病情好转、减少并发症发生率及改善预后。

To explore the application of central venous-to-arterial carbon dioxide difference to arterial-to-central venous oxygen content difference ratio (Pcv-aCO₂/Ca-cvO₂) and lactate clearance rate (LCR) in fluid resuscitation for patients with traumatic shock.

From April 2022 to April 2024, 100 patients with traumatic shock admitted to the Department of Emergency Medicine of the 908th Hospital of PLA Logistical Support Force were selected and divided into an experimental group and a control group according to the single-blind random number table method, with 50 patients in each group. Patients in the control group underwent non-invasive ultrasound cardiac output monitoring for fluid resuscitation, while patients in the experimental group were monitored for fluid resuscitation with Pcv-aCO₂/Ca-cvO₂ and LCR on the basis of the control group. The clinical indicators, acute physiology and chronic health evaluation (APACHE) Ⅱ score, sequential organ failure assessment (SOFA) score, Glasgow coma scale (GCS) score, hemodynamic indicators, complications and 28-day mortality were compared between the two groups. Meanwhile, the Kaplan-Meier survival curve was used to compare the survival conditions of the two groups.

Compared with the control group, the fluid infusion volume at 6 and 48 hours and the dosage of vasoactive drugs at 48 hours in the experimental group were much lower, and the mechanical ventilation time, ICU stay time and total hospital stay time were much shorter (all P < 0.05). There were statistically significant differences in the APACHEⅡ score (F = 5.594, P = 0.020), SOFA score (F = 4.631, P = 0.034), GCS score (F = 460.414, P < 0.001), mean arterial pressure (MAP) (F = 12.064, P < 0.001), heart rate (F = 4.233, P = 0.040) and central venous oxygen saturation (ScvO₂) (F = 7.541, P = 0.008) before and after resuscitation in the two groups. Compared with those before resuscitation, the APACHEⅡ score, SOFA score and heart rate of patients in the two groups at 6 and 24 hours after resuscitation were significantly decreased, while the GCS score, MAP and ScvO₂ were significantly increased (all P < 0.05). Moreover, the APACHEⅡ score, SOFA score, GCS score, MAP, heart rate and ScvO₂ in the experimental group were better than those in the control group (all P < 0.05). The incidence of complications [6% (3/50) vs. 20% (10/50), χ² = 4.332, P = 0.037] and the 28-day mortality rate [10% (5/50) vs. 26% (13/50), χ² = 4.336, P = 0.037] in the experimental group were much lower than those in the control group. The Kaplan-Meier survival curve showed that the survival curve of patients in the experimental group was markedly better than that in the control group (χ² = 3.900, P = 0.048).

The application of Pcv-aCO₂/Ca-cvO₂ and LCR in fluid resuscitation of traumatic shock has a good clinical effect, which can effectively stabilize hemodynamics, promote disease improvement, reduce the incidence of complications and improve prognosis.