动态监测中心静脉血氧饱和度对严重脓毒症患者预后判断的临床意义  

Monitoring central venous blood oxygen saturation for risk stratification of sepsis

作　　者：郝明伟 张琳 章车明 彭松 钟明媚 莫宝定 

机构地区：[1]安徽医科大学第三附属医院ICU,安徽合肥230001

出　　处：《中国急救医学》2016年第11期980-983,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的：探讨脓毒症患者中心静脉血氧饱和度（ScvO2）水平的变化及其对脓毒症患者预后判断的意义。方法收集109例本院ICU脓毒症患者的资料，测定入院时和入院后6 h、24 h、48 h的ScvO2、动脉血氧分压（PaO2）；根据患者入院24 h内最差临床指标，计算急性生理和慢性健康状态评分Ⅱ（APACHEⅡ评分）；根据入院时ScvO2和APACHEⅡ评分值将患者进行分组，进行相关临床资料比较。采用Logistic回归分析影响脓毒症患者预后的危险因素。结果 ScvO2下降组较 ScvO2正常组患者 APACHEⅡ评分、MODS 发生率和病死率升高，差异均有统计学意义（P＜0.05）；在 ScvO2下降的患者中，入院后6 h 经过充分复苏治疗后能够做到 ScvO2＞70%的患者，其MODS发生率和病死率较未达标的患者有所下降，差异有统计学意义（P＜0.05）。Logistic 回归分析结果显示，APACHEⅡ评分、血肌酐异常、入院后6 h 经过充分的液体复苏，ScvO2＜70%为影响患者预后的独立危险因素。结论早期 ScvO2可作为判断脓毒症患者病情严重程度的重要指标。入院后6 h ScvO2＞70%与否对判断脓毒症患者预后有重要意义。Objective This study aims to investigate the change of central venous blood oxygen saturation（ScvO2）in predicting the prognosis in the patients with sepsis. Methods We collected the information of 109 septic cases admission of our hospital. The ScvO2 and alveolar- arterial oxygen （PaO2）on admission and 6 h, 24 h, 48 h after that were measured. The patients were groups based on the worst index of acute physiology and chronic health score（APACHEⅡ assessment）within 24 h of ad-mission, and their relative clinical information was compared. Logistic regression was used to analyze the risk factors that affect the prognosis of patients with sepsis. Results Comparing with normal group pa-tients, APACHEⅡ score, MODS incidence and morbidity were increased in ScvO2 low group with statis-tical significance（P〈0.05）; in the patients with ScvO2 decreased and ScvO2〉70% after the full recov-ery treatment 6 h after admission, incidence and morbidity of MODS declined compared with ScvO2 low than standard, and the difference had statistical significance（P〈0.05）. Outcome of Logistic regression revealed that APACHE Ⅱscore, abnormal of creatinine, adequate fluid resuscitation 6 h after admission, ScvO2〈70% were independent risk factors of patients＆#39; prognosis. Conclusion Early ScvO2 could be the important index of severity in judging condition of patients with sepsis. ScvO2〉70% 6 h after admis-sion or not has important meaning in assessing the prognosis of sepsis patients.

关 键 词：中心静脉血氧饱和度(ScvO2) 脓毒症 多器官功能障碍综合征(MODS) 

分 类 号：R459.6[医药卫生—治疗学]