PaO_(2)/PaCO_(2)比值联合动脉血乳酸对心源性休克患者预后的预测价值  

Clinical significance of PaO_(2)/PaCO_(2) ratio and arterial blood lactic acid in patients with cardiogenic shock

作　　者：孙刚 郑绍鹏[1] 凌进华[1] SUN Gang;ZHENG Shaopeng;LING Jinhua(Emergency Department,Huangshan People's Hospital,Huangshan Anhui 245000,China)

机构地区：[1]黄山市人民医院急诊科,安徽黄山245000

出　　处：《中国急救复苏与灾害医学杂志》2022年第8期1074-1077,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：安徽省自然科学青年基金资助项目(编号:1808085QH235)。

摘　　要：目的探讨动脉血氧分压(PaO_(2))/动脉血二氧化碳分压(PaCO_(2))比值联合动脉血乳酸在心源性休克患者预后中的预测价值。方法选取2018年6月—2021年6月黄山市人民医院收治的86例心源性休克患者,随访28 d,统计患者生存情况。比较死亡与存活患者PaO_(2)/PaCO_(2)比值及动脉血乳酸水平,比较死亡与存活患者临床特征,采用Logistic回归分析影响心源性休克患者死亡的危险因素,采用受试者工作曲线(ROC)分析PaO_(2)/PaCO_(2)比值及动脉血乳酸水平预测心源性休克患者死亡的价值。结果随访28 d,共有37例心源性休克患者死亡,死亡率为43.02%(37/86),死亡患者PaO_(2)/PaCO_(2)比值低于存活患者(P<0.05),死亡患者动脉血乳酸水平高于存活患者(P<0.05);死亡患者性别、原发疾病、合并高血压、合并糖尿病、吸烟史、饮酒史、充血性心衰构成比以及年龄、平均动脉压、白蛋白、肌酐、尿素氮、C反应蛋白、尿酸、血红蛋白、白细胞计数、总胆固醇与存活患者比较,差异均无统计学意义(P>0.05),死亡患者心率、平均动脉压,APACHEⅡ评分与存活患者比较,差异均有统计学意义(P<0.05);Logistic多因素回归分析,结果显示平均动脉压,APACHEⅡ评分、PaO_(2)/PaCO_(2)比值及动脉血乳酸水平均是影响心源性休克患者死亡的独立危险因素(P<0.05);ROC分析显示,PaO_(2)/PaCO_(2)比值及动脉血乳酸水平预测心源性休克患者死亡的最佳截断点分别为1.36和5.64 mmol/L,灵敏度分别为81.08%和89.19%,特异度分别为75.51%和73.47%,曲线下面积(AUC)分别为0.735和0.754,二者联合的特异度和AUC分别为97.96%和0.848。结论心源性休克患者PaO_(2)/PaCO_(2)比值及动脉血乳酸水平均发生异常变化,临床检测PaO_(2)/PaCO_(2)比值及动脉血乳酸水平可作为预测心源性休克患者死亡的敏感指标。Objective To explore the clinical significance of the ratio of arterial partial pressure of oxygen(PaO_(2))/arterial partial pressure of carbon dioxide(PaCO_(2))and the detection of arterial blood lactic acid in patients with cardiogenic shock.Methods A total of 86 patients with cardiogenic shock were admitted to the hospital to undergo conventional treatment.Arterial blood samples were collected at admission to examine the concentration of lactate.Automatic blood gas analyzer was used to detect the PaO_(2)/PaCO_(2) ratio.Relevant clinical data were collected.The patients were followed up for 28 days.The prognosis was recorded.Logistic regression was used to analyze the factors influencing the outcome of the patients.Receiver operating curve(ROC)was used to analyze the values of PaO_(2)/PaCO_(2) ratioand arterial blood lactic acid to predict the death of the patients.Results The 28 d follow-up showed that 37 cardiogenic shock patients died with a mortality rate of 43.02%.The PaO_(2)/PaCO_(2) ratio of the dead patients was significantly lower than that of the surviving patients(P<0.05),and the arterial blood lactic acid level of the dead patients was significantly higher than that of the surviving patients(P<0.05).There were no significant differences in the sex,primary disease,combined hypertension,combined diabetes,history of smoking,history of drinking,congestive heart failure,age,mean arterial pressure,albumin,creatinine,urea nitrogen,C-reactive protein,uric acid,hemoglobin,white blood cell count,and total cholesterol between the dead and surviving patients(all P>0.05).The heart rate,mean arterial pressure,and APACHEⅡscore between the dead patients were significantly higher than those of the surviving patients(all P<0.05).Logistic multivariate regression analysis showed that mean arterial pressure,APACHE Ⅱ score,PaO_(2)/PaCO_(2) ratio,and arterial blood lactic acid level were independent risk factors affecting death in the patients with cardiogenic shock(all P<0.05).ROC analysis showed that the best cut-of

关 键 词：动脉血氧分压 动脉血二氧化碳分压 动脉血乳酸 心源性休克 预后 

分 类 号：R364.13[医药卫生—病理学]