分析联合应用Pcv-aCO_(2)/Ca-cvO_(2)与LCR评估脓毒症休克预后的临床价值  

The clinical value of combined application of Pcv-aCO_(2)/Ca-cvO_(2) and LCR in evaluating the prognosis of septic shock

作　　者：姚浩 张世伟 徐策 YAO Hao;ZHANG Shiwei;XU Ce(Department of Emergency Medicine,Wuxi Ninth People's Hospital,Wuxi Jiangsu 214000,China)

机构地区：[1]无锡市第九人民医院重症监护室,江苏无锡214000

出　　处：《中国急救复苏与灾害医学杂志》2022年第12期1606-1608,1613,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省卫生健康委科研项目(编号:LGY2018044)。

摘　　要：目的分析联合应用中心静脉-动脉二氧化碳分压差(Pcv-aCO_(2))/动脉-中心静脉氧含量差(Ca-cvO_(2))及乳酸清除率(LCR)评估脓毒症休克预后的临床价值。方法纳入2017年4月—2020年8月无锡市第九人民医院收治的脓毒症98例,依据28 d临床死亡结局分为死亡组(n=28)及对照组(n=70),收集并比较两组患者复苏6 h PcvaCO 2/Ca-cvO_(2)及LCR等临床资料。结果①本研究病死率为28.57%;②死亡组复苏6 h Pcv-aCO_(2)/Ca-cvO_(2)、急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和序贯器官衰竭(SOFA)评分显著高于对照组(均P<0.05),但LCR显著低于对照组(P<0.05);③Pearson相关性分析提示6 h Pcv-aCO_(2)/Ca-cvO_(2)与APACHEⅡ评分和SOFA评分呈显著正相关(均P<0.05),LCR与APACHEⅡ评分和SOFA评分呈显著负相关(均P<0.05);④PcvaCO 2/Ca-cvO_(2)联合LCR预测患者病死事件的ROC曲线下面积(AUC)(95%CI)为0.89(0.82~0.96)。结论6 h Pcv-aCO_(2)/Ca-cvO_(2)及LCR在判断脓毒症休克患者预后方面有一定应用价值,值得进一步研究。Objective To analyze the combined application of central venous-to-arterial carbon dioxide difference(Pcv-aCO_(2))/arterio-central venous oxygen content difference(Ca-cvO_(2))and lactate clearance rate(LCR)to evaluate the clinical value of the prognosis of septic shock.Methods All of 98 patients with sepsis admitted to the Ninth People's Hospital of Wuxi City from April 2017 to August 2020 were enrolled.Based on the 28-day clinical death outcome,they were divided into death group(n=28)and control group(n=70).The clinical data of 6h Pcv-aCO_(2)/CacvO_(2)and LCR were compared between the two groups of patients.Results①The fatality rate in this study was 28.57%;②The death group was resuscitated 6 h Pcv-aCO_(2)/Ca-cvO_(2),acute physiology and phronic health evaluation Ⅱ(APACHE Ⅱ)score and sequential organ failure assessment(SOFA)score was significantly higher than the control group(all P<0.05),while LCR was significantly lower than the control group(P<0.05);③Pearson correlation analysis showed that Pcv-aCO_(2)/Ca-cvO_(2)and APACHEⅡscore and SOFA score were significantly positively correlated(all P<0.05),LCR was significantly negatively correlated with APACHEⅡscore and SOFA score(both P<0.05);④6 h PcvaCO_(2)/Ca-cvO_(2)with LCR predicted patient death area under the ROC curve(AUC)(95%CI)was 0.89(0.82~0.96).Conclusion 6 h Pcv-aCO_(2)/Ca-cvO_(2)and LCR have certain application value in judging the prognosis of patients with septic shock,and it is worthy of further study.

关 键 词：中心静脉-动脉二氧化碳分压差 动脉-中心静脉氧含量差 乳酸清除率 脓毒症 死亡 

分 类 号：R631.4[医药卫生—外科学]