SvO_2、P(v-a)CO_2、LAC与APACHEⅡ评分、SOFA评分及病情的相关性研究  

Study on correlation between mixed SvO_2,P(v-a)CO_2 and LAC with APACHEⅡ score,SOFA score and disease condition

作　　者：刘辉[1] 刘剑萍[1] 张海英[1] 潘传亮[1] 

机构地区：[1]重庆医科大学附属成都第二临床学院/成都市第三人民医院重症医学科,610031

出　　处：《重庆医学》2017年第10期1326-1329,共4页Chongqing medicine

基　　金：四川省医药卫生科研基金资助项目(110033)

摘　　要：目的探讨混合静脉血氧饱和度(SvO_2)、静脉-动脉血二氧化碳分压差[P(v-a)CO_2]、血乳酸(LAC)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及序贯器官衰竭(SOFA)评分的相关性;探讨SvO_2、P(v-a)CO_2、LAC对病情的评估价值。方法收集成都市第三人民医院2011年12月至2015年3月行心脏手术患者104例,将纳入研究组的患者按预后分为存活组和死亡组。利用Pearman相关分析,分析SvO_2、P(v-a)CO_2、LAC与APACHEⅡ评分、SOFA评分的相关性,分析SvO_2、P(va)CO_2、LAC与患者病情的相关性。应用受试者工作特征(ROC)曲线评估SvO_2、P(v-a)CO_2、LAC对预后评估的准确性。结果与存活组比较,死亡组P(v-a)CO_2、LAC、APACHEⅡ评分差异有统计学意义(P<0.05)。SOFA评分(11.22 vs.7.35,t=-3.433,P<0.01)均明显升高,而SvO_2(0.65 vs.0.71,t=2.794,P<0.05)明显降低。SvO_2、LAC与SOFA评分系统有相关性(r=-0.268,P=0.006;r=0.200,P=0.041)。但P(v-a)CO_2与SOFA评分系统无相关性(r=0.190,P=0.054)。SvO_2、P(va)CO_2、LAC与APACHEⅡ评分系统有相关性(r=-0.376,P=0.000;r=0.282,P=0.004;r=0.264,P=0.007)。SvO_2、P(va)CO_2、LAC与预后有相关性(r=0.308,P=0.001;r=-0.248,P=0.011;r=-0.400,P=0.000)。SvO_2、P(v-a)CO_2、LAC对应的实际病死率的ROC曲线下面积均小于0.70。结论 SvO_2、P(v-a)CO_2、LAC与APACHEⅡ评分、SOFA评分、病情严重程度有一定的相关性,但不能作为预后的评估指标。Objective To investigate the correlation between mixed venous oxygen saturation（SVO2）,mixed venous-arterial partial pressure of carbon dioxide[-P（v-a）CO2 ] and blood lactate（LAC） with the Acute Physiology and Chronic Health Evaluation l] （APACHEⅡ ） score and Sequential Organ Failure Assessment （SOFA） score,and to investigate the value of SVOz ,P（v-a）CO2, LAC in assessing the disease condition. Methods A total of 104 atients with heart operation in the Chengdu Municipal Third Peo- ple＇s Hospital from December 2011 to March 2015 were collected and divide into survival group and non-survival group according to the prognosis. The correlation between SvO2, P（v-a）CO2 and LAC with the APACHE Ⅱ score and SOFA score was analyzed by using the Pearman correlation analysis. The correlation between SvO2 ,P（v-a）CO2 and LAC with the disease condition was also ana- lyzed. The Receiver Operating Characteristic （ROC） curve was utilized to evaluating the accuracy of SvO2 ,P（v-a）CO2 and LAC for assessing the prognosis. Results Compared with the survival group,the difference of P（v-a）CO2, LAC, APACHEⅡ scores in the non-survival group had statistical significance（P〈0.05）. SOFA score was li. 22 vs. 7.35 （t= --3. 433, P〈0.01）, all were signifi- cantly increased,but SvO2 was significantly decreased（0.65 vs. 0. 71,t= 2. 794,P〈0.05）. The values of SvO2 and LAC were sig- nificantly correlated with SOFA score （r=--0. 268,P=0. 006;r=0. 200,P=0. 041）. But P（v-a）CO2 had no correlation with SO- FA score（r= 0. 190, P= 0. 054）. The values of SvOz, P（v-a）CO2 and LAC were correlated with APACHE 11 score（r=-0. 376, P=0. 000;r=0. 282,P=0. 004;r=0. 264,P=0. 007）. The values of SvO2 ,P（v-a）CO2 and LAC were correlated with prognosis （r=0. 308,P〈0. 001;r=--0. 248,P=0. 011;r=--0. 400,P=0. 000）. The areas under ROC curve of SvO2 ,P（v-a）CO2 and LAC corresponding practical mortality all were less than 0.70. Conclusion SvO2 ,P（v-a）CO2 and LAC have a cert

关 键 词：混合静脉血氧饱和度 静脉-动脉血二氧化碳分压差 血乳酸 急性生理学与慢性健康状况评分系统Ⅱ评分 序贯器官衰竭评分 预后 

分 类 号：R459.7[医药卫生—急诊医学]