复苏后6 h Cv-aCO2/Da-vO2联合乳酸清除率对感染性休克患者预后评估价值探讨  

Prognostic Utility of Cv-aCO2/Da-vO2 Combined with Lactic Acid Clearance Rate in Patients with Septic Shock

作　　者：沈晓辉[1] 卞晓华[2] 臧会玲[1] 王生池[1] 程慧[1] 夏为 SHEN Xiao-hui;BIAN Xiao-hua;ZANG Hui-ling;WANG Sheng-chi;CHENG Hui;XIA Wei(Department of Critical Care Medicine,the First Hospital of Shijiazhuang,Shijiazhuang 050011,China;Emergency Department,the Third Hospital Affiliated to Hebei Medical University,Shijiazhuang 050000,China;Emergency Department,the 980th Hospital of PLA Joint Logistics Support Forces,Shijiazhuang 050082,China)

机构地区：[1]石家庄市第一医院重症医学科,石家庄050011 [2]河北医科大学第三附属医院急诊科,石家庄050000 [3]中国人民解放军联勤保障部队第九八〇(白求恩国际和平)医院急诊科,石家庄050082

出　　处：《临床误诊误治》2020年第8期57-61,共5页Clinical Misdiagnosis & Mistherapy

基　　金：石家庄市科学技术研究与发展指导计划(151460623);首都特色应用研究专项基金(Z181100001718026)。

摘　　要：目的探讨复苏后6 h静动脉二氧化碳含量差(Cv-aCO2)/动静脉氧含量差(Da-vO2)联合乳酸清除率对感染性休克患者预后的评估价值。方法选取感染性休克108例(≥18岁,原发病均为肺部感染),根据复苏后6 h Cv-aCO2/Da-vO2和乳酸清除率将其分为A、B、C和D组4组:A组21例,Cv-aCO2/Da-vO 2>1,乳酸清除率>0.10;B组38例,Cv-aCO2/Da-vO2>1,乳酸清除率≤0.10;C组26例,Cv-aCO2/Da-vO2≤1,乳酸清除率≤0.10;D组23例,Cv-aCO2/Da-vO2≤1,乳酸清除率>0.10。对复苏后6 h Cv-aCO2/Da-vO2、乳酸清除率和入组后第3天序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分进行析因方差分析,并比较4组入组后第3天SOFA评分及入组后28 d全因病死率。结果析因方差分析结果显示,感染性休克108例复苏后6 h Cv-aCO2/Da-vO2与入组后第3天SOFA评分相关(P<0.01);复苏后6 h乳酸清除率与入组后第3天SOFA评分也相关(P<0.05)。One-way ANOVA统计分析结果显示,4组入组后第3天SOFA评分总体比较差异具有统计学意义(P<0.01)。4组入组后第3天SOFA评分两两比较结果显示,A组与B组和C组与D组比较差异无统计学意义(P>0.05);A组与C组、A组与D组、B组与C组和B组与D组比较差异有统计学意义(P<0.05或P<0.01)。A组入组后28 d全因病死率71.43%;B组入组后28 d全因病死率73.68%,C组入组后28 d全因病死率30.77%,D组入组后28 d全因病死率26.09%,4组入组后28 d全因病死率总体比较差异具有统计学意义(P<0.01);入组后28 d全因病死率A组与B组和C组与D组比较差异无统计学意义(P>0.05),A组与C组、A组与D组、B组与C组和B组与D组比较差异有统计学意义(P<0.01)。结论复苏后6 h Cv-aCO2/Da-vO2和乳酸清除率均可以预测感染性休克患者预后,但二者联合未显示出更优预测价值。Objective To investigate the prognostic value of central venous-to-arterial carbon dioxide difference(Cv-aCO2)/arteriovenous blood oxygen difference(Da-vO2)combined with lactic acid clearance rate in patients with septic shock.Methods A total of 108 patients with septic shock(≥18 years of age,all with primary lung infection)were selected.The patients were classified into four groups according to Cv-aCO2/Da-vO2 and lactic acid clearance rate at 6 h after resuscitation:group A(Cv-aCO2/Da-vO2>1,lactate clearance rate>0.10,n=21),group B(Cv-aCO2/Da-vO2>1,lactate clearance rate≤0.10,n=38),group C(Cv-aCO2/Da-vO2≤1,lactic acid clearance rate≤0.10,n=26),and group D(Cv-aCO2/Da-vO2≤1,lactic acid clearance rate>0.10,n=23).Factorial analysis of variance was performed on Cv-aCO2/Da-vO2 and lactate clearance rate at 6 h after resuscitation,and sequential organ failure assessment(SOFA)scores at 3 d after enrollment,and the SOFA score at 3 d after enrollment and the 28-day all-cause mortality rate at 28 d after enrollment were compared.Results Factorial analysis of variance showed that Cv-aCO2/Da-vO2 at 6 h after resuscitation of 108 septic shock patients was correlated with SOFA score at 3 d after enrollment(P<0.01).Lactate clearance rate at 6 h after resuscitation was correlated with SOFA score at 3 d after enrollment(P<0.05).One-Way ANOVA analysis results showed there were statistically significant differences in SOFA score at 3 d after enrollment between the different groups(P<0.01).Multiple comparison analysis of the SOFA score at 3 d after enrollment in four groups showed that there was no significant difference between group A and group B as well as between group C and group D(P>0.05).Significant differences were found between group A and group C,between group A and group D,between group B and group C as well as between group B and group D(P<0.05 or P<0.01).The 28-day all-cause mortality rate was 71.43%in group A,73.68% in group B,30.77%in group C and 26.09% in group D after enrollment.There were statistically si

关 键 词：感染性休克 Cv-aCO2/Da-vO2 乳酸清除率 序贯器官衰竭 预后 病死率 

分 类 号：R441.9[医药卫生—诊断学]