Objective: The relationship of venous-to-arterial CO(2) difference(Pv-aCO(2))/arterial-central venous O(2) difference (Ca-vO(2)) ratio, peripheral perfusion index(PI) and lactate clearance(LC) were investigated during resuscitation in septic patients. And, the meaning of the combination PI and Pv-aCO(2)/Ca-vO(2) ratio to interpret incoherence of lactate clear was explored. Methods: The patients with sepsis were prospectively observed, who admitted to critically care medicine department of Peking Union Medical College Hospital. The hemodynamic parameters, simultaneous arterial and central venous blood gas analysis and PI were obtained at the enrollment (T0) and 8 hours (T8) during resuscitation. The lactate clearance was defined as 8h-LC≥10% and non-lactate clearance was defined as 8h-LC ≤ 10%. Additionally, the patients were divided as three sub-groups according to the PI value at T8: the normalized PI group with PI≥1.4,the mild impaired PI with 1.4<PI<0.6 and severe impaired PI with PI≤0.6. Results: A total of 84 patients were enrolled in this study. There was no significant difference in Pv-aCO(2)/Ca-vO(2) ratio in the three groups. However, the PI≤0.6 group had a significantly higher Pv-aCO(2) than other groups. Moreover, the patients with non-lactate clearance (13/32) had a higher Pv-aCO(2)/Ca-vO(2) ratio than the patients with lactate clearance in PI≥1.4 group (1.9±0.7 vs. 1.3±1.0, P=0.01). Multivariate analysis showed both Pv-aCO(2)/Ca-vO(2) ratio [Exp(B) 2.235, 95% CI 1.232-4.055, P=0.008] and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) [Exp (B) 1.087, 95%CI 1.022-1.156, P=0.008] were independent risk factor of non-lactate clearance. 8h-PI was significantly negative correlated with the 8 h Pv-aCO(2) gap (r=-0.311, P=0.004), but not significantly with Pv-aCO(2)/Ca-vO(2) ratio (r=-0.094, P=0.385). Conclusions: Both high Pv-aCO(2)/Ca-vO(2) ratio and low PI were related to non-lactate clearance after resuscitation in sepsis. Combined PI and Pv-aCO(2)/Ca-vO(2) ratio could interpret incoherence of latacte clearance after resuscitation.
目的： 分析脓毒症复苏过程中静-动脉血二氧化碳分压差（Pv-aCO(2)）/动-静脉血氧含量差（Ca-vO(2)）比值、外周灌注指数（PI）与乳酸清除的关系，初步探讨PI和Pv-aCO(2)/Ca-vO(2)比值评价乳酸清除失协调的临床意义。 方法： 选2013年11月—2014年2月北京协和医院重症医学科连续收治的放置了中心静脉导管（颈内静脉或锁骨下静脉导管）进行复苏的脓毒症患者，在入科和复苏8 h后监测PI、并行中心静脉、动脉血气分析，记录并计算动脉血氧含量（CaO(2)）、静脉血氧含量（CvO(2)）、Ca-vO(2)、Pv-aCO(2)，计算8 h乳酸清除率。应用二元logistic回归模型分析乳酸清除<10%的影响因素，相关分析采用Spearman相关系数分析。 结果： 共纳入84例脓毒症患者，复苏8 h后，PI≥1.4者45例，乳酸清除≥10%者32例；0.6<PI<1.4者20例，乳酸清除≥10%者11例；PI≤0.6者19例，乳酸清除≥10%者7例；复苏8 h后PI≥1.4者乳酸清除≥10%例数多于PI≤0.6者（P=0.01）。PI≥1.4者、0.6<PI<1.4者、PI≤0.6者间Pv-aCO(2)/Ca-vO(2)比值差异无统计学意义（1.5±1.0比1.8±1.2比1.8±1.0，P>0.05），PI≤0.6者具有显著升高的Pv-aCO(2)。复苏8 h后PI≥1.4乳酸清除<10%者Pv-aCO(2)/Ca-vO(2)比值高于乳酸清除≥10%者（1.9±0.7比1.3±1.0, P=0.01）。多因素回归分析显示，复苏8 h后Pv-aCO(2)/Ca-vO(2)比值[Exp（B）2.235，95% CI 1.232~ 4.055，P=0.008]、急性生理与慢性健康状况评分Ⅱ[Exp（B）1.087，95%CI 1.022~1.156，P=0.008]是乳酸清除<10%的独立危险因素。复苏8 h后PI与Pv-aCO(2)呈负相关（r=-0.311，P=0.004），与Pv-aCO(2)/Ca-vO(2)比值无相关性（r=-0.094，P=0.385）。 结论： 脓毒症复苏过程中，纠正异常的Pv-aCO(2)/Ca-vO(2)比值和PI有助乳酸清除。联合Pv-aCO(2)/Ca-vO(2)比值和PI有助于评价乳酸清除失协调。.
Keywords: Perfusion index; Resuscitation incoherence; Sepsis; Venous-to-arterial CO(2) difference/arterial-central venous O(2) difference ratio.