中心静脉血氧饱和度及血乳酸值对低血容量休克患者容量反应性及预后的预测价值  

Predictive value of central venous oxygen saturation and blood lactic acid level on capacity reactivity in patients with hypovolemic shock

作　　者：吴舒沁 顾增辉 吴倩 杨箬箬 骆建军 WU Shuqin;GU Zenghui;WU Qian;YANG Ruoruo;LUO Jianjun(Intensive Care Unit,the 903rd Hospital of Joint Logistic Support Force of PLA,Hangzhou 310013,China)

机构地区：[1]解放军联勤保障部队第903医院重症医学科,浙江杭州310013

出　　处：《西北国防医学杂志》2021年第5期331-336,共6页Medical Journal of National Defending Forces in Northwest China

基　　金：浙江省医药卫生科技计划项目(2019329744)。

摘　　要：目的:探讨中心静脉血氧饱和度(central venous oxygen saturation,ScvO_(2))及血乳酸(lactic acid,Lac)水平对低血容量休克患者容量反应性的预测价值。方法:选取我院重症医学科2017-01~2019-12收治的低血容量休克患者124例为研究对象,根据容量负荷试验前后的心指数(cardiac index,CI)变化评价患者容量反应性,并将患者分为有反应组(n=65)和无反应组(n=59)。对两组一般临床资料、ScvO_(2)、血Lac及相关血流动力学参数指标进行比较分析。采用Logistic回归分析低血容量休克患者容量反应阳性的危险因素,并通过受试者工作特征曲线(receiver operator characteristic curve,ROC)分析各因素的预测能力。结果:有反应组平均动脉压(mean aterial pressure,MAP)和ScvO_(2)水平显著高于无反应组,而Lac水平显著低于无反应组,差异有统计学意义(P<0.05)。Logistic回归分析发现,ScvO_(2)(OR=1.158,95%CI:1.086~1.234)与容量反应阳性呈正相关,而血Lac(OR=0.190,95%CI:0.086~0.422)则与容量反应阳性呈负相关。ROC曲线分析发现,ScvO_(2)和Lac水平的曲线下面积(area under the curve,AUC)分别为0.859和0.794,而两者联合预测概率AUC为0.917,相较于单个指标显著提升,差异有统计学意义(P<0.05)。结论:ScvO_(2)和血Lac水平对低血容量休克患者进行液体复苏后的容量反应性具有较高的预测价值,结合该两项指标进行个体化的液体复苏治疗,可提高患者治疗的安全性。Objective:To investigate the predictive value of central venous oxygen saturation(ScvO_(2))and blood lactic acid(Lac)levels on capacity reactivity in patients with hypovolemic shock.Methods:A total of 124 patients with hypovolemic shock admitted in our hospital from January 2017 to December 2019 were selected as the research subjects.According to the cardiac index(CI)before and after the volume load test,the patient′s volume responsiveness was evaluated,and the patients were divided into response group(n=65)and non-response group(n=59).The general clinical data,ScvO_(2),blood Lac and related hemodynamic parameters of the two groups were compared and analyzed.Logistic regression was used to analyze the risk factors of positive volume response in patients with hypovolemic shock,and the predictive ability of each factor was analyzed by receiver operator characteristic curve(ROC).Results:The levels of mean aterial pressure(MAP)and ScvO_(2)in the response group were significantly higher than those in the non-response group,while the level of blood Lac was significantly lower than that in the non-response group,the difference were statistically significant(P<0.05).Logistic regression analysis found that ScvO_(2)(OR=1.158,95%CI:1.086-1.234)was positively correlated with positive volume response,while blood Lac(OR=0.190,95%CI:0.086-0.422)was negatively correlated with positive volume response.ROC curve analysis showed that the area under the curve(AUC)of the ScvO_(2)and blood Lac level indicators were 0.859 and 0.794 respectively,and the combined prediction probability of the two was 0.917,which was significantly improved compared to the single indicator,and the difference were statistically significant(P<0.05).Conclusion:The ScvO_(2)and blood Lac indicators have a high predictive value for the volume response of patients with hypovolemic shock after fluid resuscitation.Combining these two indicators for individualized fluid resuscitation treatment can improve the safety of patients′treatment.

关 键 词：中心静脉血氧饱和度 乳酸 预测价值 容量反应性 

分 类 号：R446[医药卫生—诊断学]