PtcO2/PtcCO2比值对脓毒性休克患者集束化治疗微循环变化的评估及预后价值分析  

Evaluation of microcirculatory changes after bundle therapy and prognostic value by the ratio of transcutaneous oxygen pressure and transcutaneous carbon dioxide pressure in the treatment of septic shock

作　　者：张文娟[1] 邵俊[1] 吴晓燕[1] 於江泉[1] 郑瑞强[1] Zhang Wenjuan;Shao Jun;Wu Xiaoyan;Yu Jiangquan;Zheng Ruiqiang(Department of Critical Care Medicine,Northern Jiangsu People's Hospital,Yangzhou 225000,Jiangsu,China)

机构地区：[1]江苏省苏北人民医院重症医学科,江苏扬州225000

出　　处：《中华危重病急救医学》2019年第12期1521-1526,共6页Chinese Critical Care Medicine

基　　金：江苏省扬州市科技计划项目(YZ2017086)。

摘　　要：目的应用经皮氧分压(PtcO2)、经皮二氧化碳分压(PtcCO2)等指标评估脓毒性休克患者集束化治疗前后微循环的变化,并探讨其在预测预后方面的价值.方法回顾性分析2017年7月至2019年2月江苏省苏北人民医院重症医学科(ICU)收治的脓毒性休克成人患者的临床资料.收集患者性别、年龄、感染部位、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、ICU住院时间及28 d预后情况;集束化治疗前(入院时)及治疗6 h的PtcCO2、PtcO2、PtcO2/PtcCO2比值、动脉血乳酸(Lac)、中心静脉血氧饱和度(ScvO2)、平均动脉压(MAP)等指标.根据28 d预后将患者分为存活组和死亡组,比较两组间各指标的差异;应用二元Logistic回归分析预后危险因素;绘制受试者工作特征曲线(ROC),评价相关指标对脓毒性休克患者28 d病死率的预测价值.结果共纳入脓毒性休克患者78例,其中存活组47例,死亡组31例.与存活组比较,死亡组基线指标中APACHEⅡ评分、PtcCO2更高〔APACHEⅡ(分):28.33±6.35比21.61±6.64,PtcCO2(mmHg,1 mmHg=0.133 kPa):51.80±19.05比38.17±6.79,均P<0.05〕,PtcO2/PtcCO2比值更低(1.20±0.72比1.80±0.81,P<0.05).与治疗前比较,脓毒性休克患者集束化治疗6 h PtcO2/PtcCO2比值、Lac水平、MAP均明显改善〔PtcO2/PtcCO2比值:1.76±0.81比1.56±0.82,Lac(mmol/L):3.74±2.40比4.42±2.60,MAP(mmHg):83.34±7.58比71.00±5.36,均P<0.05〕,而PtcCO2、ScvO2无明显变化.存活组集束化治疗6 h PtcO2/PtcCO2比值明显高于治疗前,且明显高于死亡组(2.13±0.75比1.80±0.81、1.19±0.53,均P<0.05);死亡组治疗前后PtcO2/PtcCO2比值无明显变化(1.19±0.53比1.20±0.72,P>0.05).二元Logistic回归分析显示,集束化治疗6 h PtcO2/PtcCO2比值、APACHEⅡ评分是影响脓毒性休克患者预后的独立危险因子〔PtcO2/PtcCO2比值:优势比(OR)=7.876,P=0.026;APACHEⅡ评分:OR=0.846,P=0.035〕.ROC曲线分析显示,6 h的PtcO2/PtcCO2比值、APACHEⅡ评分和6 h Lac水平均可预测脓毒性Objective To evaluate microcirculatory changes after bundle therapy and prognostic values of the ratio of transcutaneous oxygen pressure and transcutaneous carbon dioxide pressure(PtcO2/PtcCO2)in the treatment of septic shock.Methods A retrospective analysis was conducted.Patients with septic shock admitted to department of intensive care unit(ICU)of Northern Jiangsu People's Hospital from July 2017 to February 2019 were enrolled.The gender,age,infection site,acute physiology and chronic health evaluationⅡ(APACHEⅡ),the length of ICU stay and 28-day prognosis were collected;PtcCO2,PtcO2,PtcO2/PtcCO2 ratio,arterial lactate(Lac),central venous oxygen saturation(ScvO2),mean arterial pressure(MAP)were measured before treatment(at admission)and 6 hours after bundle treatment.According to the 28-day prognosis,the patients were divided into survival group and death group,and the differences of each index between the two groups were compared.The risk factors of prognosis were analyzed by binaryLogistic regression analysis.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of the related indicators for the 28-day mortality of septic shock patients.Results A total of 78 patients with septic shock were enrolled,with 47 cases in survival group and 31 cases in death group.Compared with survival group,APACHEⅡscore and PtcCO2 were higher and PtcO2/PtcCO2 ratio was lower in death group[APACHEⅡ:28.33±6.35 vs.21.61±6.64,PtcCO2(mmHg,1 mmHg=0.133 kPa):51.80±19.05 vs.38.17±6.79,PtcO2/PtcCO2 ratio:1.20±0.72 vs.1.80±0.81,all P<0.05].Compared with before treatment,the PtcO2/PtcCO2 ratio,Lac,MAP were substantially improved at 6 hours of bundle therapy[PtcO2/PtcCO2 ratio:1.76±0.81 vs.1.56±0.82,Lac(mmol/L):3.74±2.40 vs.4.42±2.60,MAP(mmHg):83.34±7.58 vs.71.00±5.36,all P<0.05],and there was no changes in PtcCO2 and ScvO2.The PtcO2/PtcCO2 ratio at 6 hours of bundle therapy in the survival group was significantly higher than before treatment and was higher than that in death group(2.13

关 键 词：脓毒性休克 经皮氧分压 经皮二氧化碳分压 经皮氧分压/经皮二氧化碳分压比值 微循环 预后 

分 类 号：R45[医药卫生—治疗学]