Abstract:
Objective 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.
Methods 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.
Results 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).
Conclusions 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.
Key words:
Shock, traumatic,
Liquid resuscitation,
Non-invasive cardiac output monitoring,
Central venous-to-arterial carbon dioxide difference,
Arterial-to-central venous oxygen content difference,
Lactate clearance rate
Zhenqi Xu, Ye Peng, Wei Yi, Shanshan Li, Jinfeng Wang, Biao He. Value of central venous-to-arterial carbon dioxide difference to arterial-to-central venous oxygen content difference ratio and lactate clearance rate in fluid resuscitation of patients with traumatic shock[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2025, 18(03): 197-203.