关键词: 碳酸氢钠林格液, 乳酸靶向复苏, 感染性休克, 生命体征, 乳酸, 电解质, 并发症

Abstract: Objective To explore the application effect of sodium bicarbonate Ringer’s solution combined with lactate targeted resuscitation on patients with septic shock．Methods A total of 80 patients with septic shock admitted to the 988 Hospital,Joint Logistic Support Force of the Chinese People’s Liberation Army from January 2019 to December 2023 were selected and divided into observation group and control group by random number table method,with 40 cases in both groups．The control group was treated with compound sodium chloride solution for liquid resuscitation,and the observation group was treated with sodium bicarbonate Ringer’s solution combined with lactic acid for targeted resuscitation．The changes in SvO₂,MAP,CI,HR,as well as changes in blood lactate,pH,Na⁺,Cl^-,and HCO₃^- levels were compared between two groups of patients before and 24 hours after resuscitation．The time for symptom disappearance,consciousness recovery,mechanical ventilation,and ICU hospitalization were compared between the two groups of patients,as well as total length of hospital stay,poor prognosis,and incidence of complications．Results That the SvO₂,MAP,and CI were elevated in both groups after resuscitation,and of the observation group （SvO₂[73.62±6.24]%,MAP[75.26±11.42]mmHg,CI[3.62±0.66]min/m²）was higher than that of the control group （[66.85±8.32]%,[68.51±8.37]mmHg,[3.16±0.35]min/m²）,the HR was decreased in all cases,the observation group（113.26±12.37）times/min was lower than the control group（122.62±12.73）times/min,the difference was statistically significant（t=4.117,P<0.001;t=3.015,P=0.003;t=3.894,P<0.001;t=3.335,P<0.001）．After resuscitation,both groups blood lactate and Cl^- were decased,pH value,Na⁺,and HCO₃^- increased,and the observation group blood lactate（1.46±0.52）mmol/L was lower than the control group（2.25±0.32）mmol/L,the difference was statistically significant（t=8.183,P<0.001）．But the comparison of pH value,Na⁺,Cl^-,and HCO₃^- levels between the two groups was not different（P>0.05）．Time of disappearance（2.34±0.58）d,time of consciousness（1.15±0.27）d,time of mechanical ventilation（5.82±1.08）d,length of ICU stay（11.85±2.28）d and total length of stay（[23.15±4.26]d,[3.54±0.72]d, [2.95±0.34]d,[10.35±2.12]d,[15.12±3.23]d,[27.24±6.37]d）,the difference was statistically significant（t=8.209,P<0.001,t=26.221,P<0.001,t=12.042,P<0.001;t=5.231,P<0.001;t=3.376,P<0.001）．The incidence of multiple organ dysfunction syndrome,pulmonary edema,cerebral edema,reshock,and death in the observation group was significantly lower than that in the control group（7.50% vs 32.50%;χ²=7.810,P=0.005,P<0.05）．Conclusions The combination of sodium bicarbonate Ringer’s solution and lactate targeted resuscitation can improve the vital signs of septic shock patients,reduce lactate levels,significantly improve patient prognosis,shorten hospital stay,and assist in reducing the incidence of complications and mortality．

Key words: sodium bicarbonate ringer solution, lactic acid targeted resuscitation, infectious shock, vital signs, lactic acid, electrolytes, complications