经皮氧分压监测对行体外膜氧合治疗的心源性休克患者预后评估的价值  

Effect of transcutaneous oximetry on prognosis of patients with cardiogenic shock receiving extracorporeal membrane oxygenation

作　　者：董亮[1] 李朗[1] 张秀红[1] 严正[1] 严洁[1] 

机构地区：[1]南京医科大学附属无锡人民医院重症医学科,江苏无锡214023

出　　处：《中国急救医学》2017年第8期694-698,共5页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金（81400054）;江苏省自然科学基金（BK20140122）;江苏省青年医学人才项目（QNRC2017179）

摘　　要：目的探讨经皮氧分压监测对行体外膜氧合（ECMO）治疗的心源性休克患者预后评估的价值。方法选取2012—06—2015—05南京医科大学附属无锡人民医院重症医学科（ICU）收治的因心源性休克而接受静脉-动脉（V—A）ECMO治疗的患者共41例。在接受ECMO治疗后6h进行经皮氧分压监测和氧负荷试验，计算6h的10min氧负荷值（10minOCT）及氧负荷指数（OCI），并收集ECMO治疗首日患者的一般资料、血常规生化指标、APACHEⅡ评分。依据ECMO治疗后60d生存情况将患者分为存活组和死亡组，比较两组患者10minOCT、OCI及APACHEⅡ评分。采用受试者工作特征（ROC）曲线分析10minOCT、OCI值及APACHEⅡ评分对患者预后的判断价值，采用Kaplan—Meier法绘制患者的生存曲线，Log—rank法分析患者生存情况，多因素Logistic回归分析筛选患者预后相关危险因素。结果存活组和死亡组分别纳入19例及22例患者，存活组10minOCT[（78．00±19．15）mmHgvs．（55．41±15．68）mmHg，P〈0．05]及OCI[（0．75±0．15）VS．（0．61±0．15），P〈0．05]均高于死亡组，存活组APACHEII评分[（11．37±5．54）VS．（19．45±6．47），P〈0．05]低于死亡组。10minOCT预测患者60d死亡的ROC曲线下面积为0．82±0．07（95％C10．67～0．92，P〈0．05）。OCI值预测患者60d死亡的ROC曲线下面积为0．75±0．08（95％c10．59～0．87，P〈0．05）。Kaplan—Meier生存曲线分析显示，分另0以10minOCT=72．00BinHg（66．7％VS．25．0％）和OCI=0．70（77．8％VS．21．7％）为最佳界值分组患者60d生存率差异有统计学意义（均P〈0．05）。多因素Logistic回归分析显示APACHEⅡ评分（OR=1．21，95％CI1．08—1．36，P〈0．05）、6h10minOCT（OR=0．93，95％C10．89—0．97，P〈0．05）、OCI（OR=0．002，95％C10．001—0．223，P〈0．05）均是患者死亡的相关因素。结论经皮氧分压监测是早期预测行ECMObjective To evaluate effect of transcutaneous oximetry on prognosis of patients with cardiogenic shock receiving extracorporeal membrane oxygenation （ECMO）. Methods Forty -one patients with cardiogenic shock supported by Veno -Arterial （V -A） ECMO were prospectively enrolled from June 2012 to May 2015. 10 min oxygen challenge test were measured using transcutaneous oximetry at 6 hours after ECMO initiation respectively, 10 min OCT value （10 min OCT） and oxygen challenge index（OCI） were then calculated. Patients were divided into the survival group and the death group based on the 60 days survival status. 10 rain OCT, OCI and APACHE Ⅱ score were compared between groups. The effect of 10 min OCT, OCI and APACHEⅡ score for predicting death was evaluated by receiver operating characteristic （ROC） curves. The surviving curve was created using the Kaplan - Meier method, and the survival of the patients was analyzed by the Log - rank test. Risk factors associated with the prognosis were analyzed using the multiple logistic regression analysis. Results There were 19 patients and 22 patients in survival group and death group respectively. 10 min OCT [ （78.00 ± 19.15） mm Hg vs. （55.41 ± 15.68） mm Hg], OCI[ （0.75 ±0.15） vs. （0.61 ±0.15） ]at 6 h and APACHE Ⅱ score[ （ 11.37±5.54） vs. （ 19.45 ±6.47 ） ] were all significantly different between survivors and nonsurvivors （ P 〈 0.05 ）. The area under the ROC curve of 10 min OCT and OCI for predicting death were [ （ 0.82± 0. 07 ） 95 % CI 0.67 ± 0.92 ] and [ （ 0.75± 0.08 ） 95 % CI 0.59± 0.87 ], respectively. The best cutoff point for 10 min OCT was 72.0 mm Hg with a sensitivity of 86.4% and specificity of 73.7%. The best cutoff point for OCI was 0.70 with a sensitivity of 81.8% and specificity of 70.0%. Kaplan - Meier survival analysis indicated that 60 days survival rate of high 10 rain OCT and high OCI group were significantly higher than those of low 10 min OCT （66.7 % vs. 25.0% , P 〈 0.05 ） and low

关 键 词：经皮氧分压监测 体外膜氧合(ECMO) 心源性休克 预后 

分 类 号：R563.805[医药卫生—呼吸系统]