组织血氧饱和度与血乳酸对早期急诊感染性休克患者预后的评估价值  

Evaluation value of tissue oxygen saturation and blood lactate level in early prognosis of emergency patients with septic shock

作　　者：刘铮[1] 刘志[1] 张海英[1] 刘伟[1] 董雪松[1] Liu Zheng;Liu Zhi;Zhang Hai-ying;Liu Wei;Dong Xue-song(The First Affiliated Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院急诊科,辽宁沈阳110001

出　　处：《中国急救医学》2020年第4期319-323,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的 通过比较感染性休克患者组织血氧饱和度(StO2)、StO2变化率、早期血乳酸、乳酸清除率对其28 d病死率的影响,探讨StO2对急诊感染性休克患者预后的评估价值.方法 根据纳入标准,回顾性收集中国医科大学附属第一医院急诊监护室(EICU)收治的感染性休克患者48例,收集入组患者0、6、12、24、48 h的血乳酸水平和StO2,根据患者28 d预后情况分为生存组和死亡组,分别比较早期不同时段的StO2、StO2变化率、血乳酸、乳酸清除率对其预后的影响,用受试者工作特征曲线(ROC)下面积(AUC)比较StO2、StO2变化率、血乳酸、乳酸清除率在感染性休克早期不同时段对28 d病死率的预测效力,对入组患者的StO2和血乳酸水平进行相关性分析.结果 48例患者中,生存组34例(70.8%),死亡组14例(29.2%),血乳酸水平、乳酸清除率、StO2在生存组和死亡组早期不同时段的差异有统计学意义(P<0.05),StO2变化率在12 h后生存组和死亡组的差异有统计学意义(P<0.05).血乳酸在5个时段预测28 d病死率的AUC分别为:0.61、0.65、0.67、0.69、0.71;StO2在5个时段预测28 d病死率的AUC分别为:0.56、0.59、0.63、0.64、0.67;乳酸清除率在4个时段预测28 d病死率的AUC分别为:0.68、0.71、0.75、0.78;StO2变化率在4个时段预测28 d病死率的AUC分别为:0.45、0.66、0.68、0.71.Pearson相关性分析显示入组患者的StO2和血乳酸水平呈负相关(r=-0.274,P<0.05).结论 StO2和12 h后StO2变化率可以作为早期预测急诊感染性休克患者28 d死亡风险的指标,对判断预后和指导感染性休克治疗具有较高的应用价值.Objective To compare the effects of tissue oxygen saturation(St02),St02 change rate,early lactic acid value and lactic acid clearance rate on 28-day mortality in the patients with septic shock,and to explore the value of St02 in evaluating the prognosis of emergency septic shock patients.Methods According to the inclusion criteria,48 patients with septic shock in the emergency intensive care unit of our hospital were collected retrospectively.The lactic acid values and St02 values were collected at 0,6,12,24 and 48 h.The patients were divided into survival group and death group according to the 28-day prognosis.The effects of St02 value,St02 change rate,lactic acid value and lactic acid clearance rate on the prognosis were compared.The area under ROC curve was used to compare the predictive effect of St02 value,St02 change rate,lactic acid value and lactic acid clearance rate on 28-day mortality at the early stage of septic shock,and the correlation between St02 value and lactic acid value was analyzed.Results Among the 48 patients,there were 34 cases(70.8%)in survival group and 14 cases(29.2%)in death group.There were significant differences in lactic acid value,lactic acid clearance rate and St02 value between survival group and death group(P<0.05).There was significant difference in St()2 change rate between survival group and death group after 12 hours(P<0.05).The AUC of lactate value for predicting 28-day mortality was 0.61,0.65,0.67,0.69 and 0.71.The AUC of St02 for predicting 28-day mortality was 0.56,0.59,0.63,0.64 and 0.67.The AUC of lactate clearance rate for predicting 28-day mortality was 0.68,0.71,0.75 and 0.78.The AUC of St02 change rate for predicting 28-day mortality was 0.45,0.66,0.68 and 0.71.Pearson correlation analysis showed the correlation coefficient between St02 and blood lactic acid was-0.274(P<0.05).Conclusion The value of St02 and the St02 change rate after 12 hours c an be used as early indexes to predict the risk of death in the patients with emergency septic shock,and have high value

关 键 词：组织血氧饱和度(StO2) 血乳酸 感染性休克 

分 类 号：R459.7[医药卫生—急诊医学]