胃黏膜pH值和PgCO_(2)及PaCO_(2)血气变化对小儿重症肺炎合并胃黏膜炎症损伤诊断价值  

Clinical diagnostic value of gastric mucosal pH,PgCO_(2) and PaCO_(2) blood gas changes in severe pneumonia children combined with gastric mucosal inflammation

作　　者：王淑珍 张薇 羊玲 钟丽花 王梅[3] WANG Shu-zhen;ZHANG Wei;YANG Ling;ZHONG Li-hua;WANG Mei(Hainan Women and Children's Medical Center,Haikou,Hainan 570100,China;不详)

机构地区：[1]海南省妇女儿童医学中心儿科,海南海口570100 [2]海南省妇女儿童医学中心新生儿科,海南海口570100 [3]海口市妇幼保健院儿科,海南海口570100

出　　处：《中华医院感染学杂志》2021年第16期2527-2531,共5页Chinese Journal of Nosocomiology

基　　金：海南省卫生健康行业科研基金资助项目(19A200074)。

摘　　要：目的探讨胃黏膜pH值和胃黏膜二氧化碳分压(PgCO_(2))、动脉血二氧化碳分压(PaCO_(2))等血气变化情况对小儿重症肺炎合并胃黏膜损伤的临床诊断价值。方法选取2017年11月-2019年11月海南省妇女儿童医学中心收治的重症肺炎合并胃黏膜损伤患儿61例作为研究组,同时选择同期诊断为重症肺炎但未合并胃黏膜损伤患儿74例作为对照组,所有患儿均行机械通气,比较两组患儿通气前和通气24 h、48 h后胃黏膜pH值和血气变化情况,对胃黏膜pH值与血气指标进行相关性分析,并分析胃黏膜pH值对重症肺炎合并胃黏膜损伤诊断价值。结果研究组患儿通气前胃黏膜pH值和血气指标均低于对照组,通气后24 h、48 h,两组患者各指标均明显改善,胃黏膜pH值、PaO_(2)和PaO_(2)/FiO_(2)呈逐渐上升趋势,PgCO_(2)-PaCO_(2)呈逐渐下降趋势,研究组胃黏膜pH值、PgCO_(2)-PaCO_(2)、PaO_(2)、PaO_(2)/FiO_(2)低于对照组,差异有统计学意义(P<0.05)。对通气后24 h资料行Pearson相关分析:胃黏膜pH值与PgCO_(2)-PaCO_(2)水平呈负相关,与PaO_(2)和PaO_(2)/FiO_(2)呈正相关(P<0.05)。胃黏膜pH值、PgCO_(2)-PaCO_(2)、PaO_(2)、PaO_(2)/FiO_(2)4个指标对重症肺炎合并胃黏膜损伤的诊断均具有一定的价值,其中,胃黏膜pH值的ROC-AUC为0.751(0.584~0.965);胃黏膜pH值和其他指标的联合应用的ROC-AUC为0.804(0.700~0.923)。结论胃黏膜pH值可准确、敏感地反映重症肺炎患儿胃黏膜损伤情况,PgCO_(2)、PaCO_(2)等血气指标可准确判断机体是否存在酸碱平衡失调和缺氧程度,反映胃黏膜灌注情况。OBJECTIVE To explore the clinical value of gastric mucosal pH,PgCO_(2),PaCO_(2) and other blood gas changes in the diagnosis of gastric mucosal injury in children.METHODS From Jan 2018 to May 2019,61 children with severe pneumonia and gastric mucosal injury were recruited in the study group and 74 children with severe pneumonia but without gastric mucosal injury during the same period were in the control group.All the children were given mechanical ventilation.The changes of gastric mucosal pH and blood gas before ventilation,24 hours after and 48 hours after ventilation were compared between the two groups.The correlation between the changes of gastric mucosal pH and blood gas indexes was analyzed.The value of pH value of gastric mucosa in the diagnosis of severe pneumonia with gastric mucosa injury was analyzed.RESULTS The gastric mucosal pH and blood gas indexes in the study group were significantly lower than those in the control group before ventilation.At 24 h and 48 h after ventilation,the indexes in the two groups were significantly improved.The gastric mucosal pH,PaO_(2) and PaO_(2)/FiO_(2) showed a gradual upward trend.PgCO_(2)-PaCO_(2) showed a gradually decreasing trend.The gastric mucosal PH value,PgCO_(2)-PaCO_(2),PaO_(2) and PaO_(2)/FiO_(2) in the study group were still lower than those in the control group;the difference between them was significant(P<0.05).Pearson correlation analysis was performed on the 24 h post-ventilation data:gastric mucosal PH value was negatively correlated with PgCO_(2)-PaCO_(2) level,and positively correlated with PaO_(2) and PaO_(2)/FiO_(2)(P<0.05).Four indicators such as gastric mucosal PH value,PgCO_(2)-PaCO_(2),PaO_(2) and PaO_(2)/FiO_(2) had certain value in the diagnosis of severe pneumonia complicated with gastric mucosal injury.Among them,the ROC-AUC of gastric mucosal PH value was 0.751(0.584~0.965).The ROC-AUC of the combination of gastric mucosal PH value and other indicators was 0.804(0.700~0.923).CONCLUSION The pH value of gastric mucosa can accurately and

关 键 词：胃黏膜PH值 血气分析 重症肺炎 胃黏膜损伤 

分 类 号：R725.6[医药卫生—儿科]