外周动静脉血血气分析差异对复苏后感染性休克患者预后的预测价值  

Prognostic value of differences between peripheral arterial and venous blood gas analysis in patients with septic shock

作　　者：高伟[1] 朱启勇[1] 倪海滨[1] 张家留[1] 周丹丹[1] 殷丽萍[1] 张丰[1] 陈浩[1] 张蓓蓓[1] 李伟[1] Gao Wei;Zhu Qiyong;Ni Haibin;Zhang Jialiu;Zhou Dandan;Yin Liping;Zhang Feng;Chen Hao;Zhang Beibei;Li Wei(Department of Intensive Care Unit,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanfing University of Chinese Medicine,Nanjing 210028,Jiangsu,China)

机构地区：[1]南京中医药大学附属中西医结合医院重症医学科,江苏南京210028

出　　处：《中华危重病急救医学》2018年第8期722-726,共5页Chinese Critical Care Medicine

基　　金：国家自然科学基金（81673932）;国家中医药管理局“十二五”重点专科培育项目（ZPI001ZZ012）;江苏省中医药局科技项目（YB2015040）;中国中医科学院江苏分院青年课题（JSBY1307）

摘　　要：目的 探讨外周动静脉血血气分析指标及其相应差值对感染性休克患者预后的预测价值.方法 选择2016年5月至2017年12月南京中医药大学附属中西医结合医院重症医学科（ICU）收治的年龄18～80岁的感染性休克患者,按照集束化治疗方案进行治疗,使用血气生化仪测定患者早期复苏后6 h的外周动脉血及外周静脉血血气分析指标,记录pH值、氧分压（PO2）、二氧化碳分压（PCO2）、剩余碱（BE）、碳酸氢盐（HCO3-）及乳酸（Lac）水平,并计算动脉血与静脉血各指标的差值.根据28 d预后将患者分为存活组与死亡组,采用多因素Logistic回归分析筛选患者死亡的危险因素,并通过受试者工作特征曲线（ROC）评估各指标差值对患者预后的预测价值.结果 共入选65例感染性休克复苏达标患者,28 d存活35例,死亡30例.① 两组患者性别、年龄以及初始复苏6 h后的平均动脉压（MAP）、中心静脉压（CVP）、中心静脉血氧饱和度（ScvO2）和去甲肾上腺素用量比较差异均无统计学意义.② 与存活组比较,死亡组患者动静脉血Lac水平及其Lac差值（ΔLac）,以及动静脉血PCO2差值（ΔPCO2）均明显升高〔动脉血Lac（mmol/L）：7.40±3.10比4.82±2.91,静脉血Lac（mmol/L）：9.17±3.27比5.81±3.29,ΔLac（mmol/L）：1.77±0.54比0.99±0.60,ΔPCO2（mmHg,1 mmHg=0.133 kPa）：9.64±5.08比6.70±3.71,均P〈0.01],其他动静脉血血气分析指标及其相应差值差异均无统计学意义.③ 多因素Logistic回归分析显示,ΔPCO2和ΔLac是感染性休克患者28 d死亡的独立危险因素〔ΔPCO2：β=0.247,优势比（OR）=1.280,95％可信区间（95％CI）=1.057～1.550,P=0.011;ΔLac：β=2.696,OR=14.820,95％CI=2.916～75.324,P=0.001].④ROC曲线分析显示,动脉血Lac、ΔLac和ΔPCO2对感染性休克患者预后均有预测价值,ROC曲线下面积（AUC）分别为0.792、0.857和0.680（均P〈0.05）.动脉血Lac最佳临界值为4.00 mmol/L� Objective To investigate the value of the difference between peripheral arterial and venous blood gas analysis for the prognosis of patients with septic shock after resuscitation.Methods Patients with septic shock aged 18 to 80 years admitted to intensive care unit （ICU） of Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine from May 2016 to December 2017 were enrolled. The peripheral arterial blood and peripheral venous blood gas analysis were measured simultaneously after the early 6 hours resuscitation, including pH, partial pressure of oxygen （PO2）, partial pressure of carbon dioxide （PCO2）, base excess （BE）, bicarbonate （HCO3-） and lactate （Lac） level, and the difference values between peripheral arterial and venous blood were calculated. According to the 28-day survival, the patients were divided into survival group and death group. Multiple Logistic regression analysis was used to analyze the risk factors of death, and the receiver operating characteristic curve （ROC） was used to analyze the prognostic value of blood gas analysis parameters for prognosis.Results A total of 65 patients with septic shock resuscitation were enrolled in the study, 35 survived while 30 died during the 28-day period. ① There was no significant difference in gender, age, and mean arterial pressure （MAP）, central venous pressure （CVP）, central venous oxygen saturation （ScvO2） and norepinephrine （NE） dose between the two groups.② The arterial and venous Lac, the difference of Lac （ΔLac） and PCO2 （ΔPCO2） between arterial and venous blood in death group were significantly higher than those in survival group [arterial Lac （mmol/L）： 7.40±3.10 vs. 4.82±2.91, venous Lac （mmol/L）： 9.17±3.27 vs. 5.81±3.29, ΔLac （mmol/L）： 1.77±0.54 vs. 0.99±0.60, ΔPCO2 （mmHg, 1 mmHg =0.133 kPa）： 9.64±5.08 vs. 6.70±3.71, allP 〈 0.01], and there was no significant difference in the other arterial an

关 键 词：感染性休克 外周动脉血 外周静脉血 血气分析 差值 预后 

分 类 号：R459.7[医药卫生—急诊医学]