重症肺炎患者监测中心静脉血氧饱和度的意义  

Significance for Monitoring Central Venous Oxygen Saturation in Patients with Severe Pneumonia

作　　者：舒伟锋[1] 方堃[1] 李国辉[1] 石占利[1] 

机构地区：[1]杭州市红十字会医院ICU,浙江省杭州市310003

出　　处：《中国全科医学》2009年第23期2116-2118,共3页Chinese General Practice

基　　金：杭州市医药卫生科技计划项目(2007A019)

摘　　要：目的探讨中心静脉血氧饱和度(ScvO2)在重症肺炎患者中的应用价值。方法随机选择2006年1月—2009年4月我院符合重症肺炎诊断的患者90例,每天1次监测患者ScvO2,根据监测结果将所有病例分为两组:A组为前2次ScvO2检测值均<65%(共38例),B组为对照组(即前2次ScvO2检测值至少有1次≥65%,共52例)。比较两组患者的28d病死率、多脏器功能障碍综合征(MODS)发生率、严重脓毒症(SEPSIS)发生率、急性心力衰竭发生率、急性肾衰竭发生率,以及两组患者在病程中ScvO2及血乳酸水平的变化情况。结果两组患者的28d病死率、MODS发生率、严重SEPSIS发生率、急性心力衰竭发生率、急性肾衰竭发生率比较差异均有统计学意义(P<0.05)。随病情进展,A组患者ScvO2水平呈逐渐下降趋势,且A组检测值与B组比较差异均有统计学意义(P<0.05)。A组患者血乳酸水平第15天起出现明显升高,第15～28天检测值与B组比较差异均有统计学意义(P<0.01)。结论ScvO2可以反映重症肺炎患者的病情严重度,可能可以作为患者预后的早期预测指标之一,且ScvO2的降低程度与患者的病情危重性存在明显相关性,若出现ScvO2持续降低,则患者的病死率将大大增加。在病情发展中,ScvO2比乳酸等监测指标更早出现异常,是一个较为灵敏的监测指标。Objective To study the clinical value of central venous oxygen saturation （ScvO2） in patients with severe pneumonia, Methods Totally 90 patients with severe pneumonia were randomly selected from January 2006 to April 2009, the ScvO2 was monitored once a day, All the patients were divided into two groups according to the results of the monitoring： group A （n=38） in which the values of ScvO2 for the first two times 〈65%, and group B （controls, n=52） in which the value of ScvO2≥ 65% at least for one time in the first two. The conditions of the two groups were compared, including incidences of death, multiple organ dysfunction syndromes （MODS）, severe sepsis, acute cardiac failure and acute renal failure during the 28 days, as well as the changes of ScvO2 and serum lactic acid during the courses. Results There were significant differences between the two groups in the incidences of death, MODS, severe sepsis, acute cardiac failure and acute renal failure during the 28 days （P〈0.05）. With the progress of disease, the ScvO2 value of group A was in a tendency of decrease and was significantly different from that of group B （P〈0.01）. The value of serum lactic acid of group A was significantly increased from the 15th day and significantly different from that of group B （P〈0.01） from 15th to 28th day. Conclusion ScvO2 can reflect the severity of patient＇ s condition and serve as one of early prediction of prognosis. The degree of ScvO2 decrease is remarkably correlated with the severity of disease. The mortality will increase when ScvO2 is at a low level persistently. Furthermore, ScvO2 change as a sensitive index occurs earlier than serum lactic acid.

关 键 词：重症肺炎 中心静脉血氧饱和度 血乳酸 

分 类 号：R563.1[医药卫生—呼吸系统]