Pv-aCO_(2)/Ca-vO_(2)联合血乳酸对儿童原发性腹膜炎相关脓毒性休克预后的预测价值  

Predictive value of Pv-aCO_(2)/Ca-vO_(2) combined blood lactate concentration for primary peritonitis-related septic shock in children

作　　者：马乐[1] 田家豪 李艺佩 王莹[1] 杜彦强 王义[1] Ma Le;Tian Jiahao;Li Yipei;Wang Ying;Du Yanqiang;Wang Yi(Department of Paediatric Intensive Care Unit,the Children's Hospital Affiliated to Xi'an Jiaotong University,Xi'an 710003,Shaanxi,China;The School of Basic Medical Science of the Health Science Center(HSC)of Xi'an Jiaotong University,Xi'an 710061,Shaanxi,China)

机构地区：[1]西安交通大学附属儿童医院重症医学科,陕西西安710003 [2]西安交通大学医学部基础医学院,陕西西安710061

出　　处：《中华危重病急救医学》2023年第1期77-81,共5页Chinese Critical Care Medicine

基　　金：陕西省西安市科技计划医学研究项目(21YXYJ0009)。

摘　　要：目的:探讨静脉-动脉血二氧化碳分压差与动脉-静脉血氧含量差比值(Pv-aCO_(2)/Ca-vO_(2))对儿童原发性腹膜炎相关脓毒性休克预后的预测价值。方法:采用回顾性研究,选取2016年12月至2021年12月西安交通大学附属儿童医院重症医学科收治的63例腹膜炎相关脓毒性休克患儿作为研究对象。以28 d全因病死率为主要终点事件,根据预后将患儿分为生存组及死亡组,统计两组基线资料及血气分析、血常规、凝血、炎症状态、危重评分等相关临床数据。对影响预后的因素进行多因素Logistic回归分析,并通过受试者工作特征曲线(ROC曲线)对危险因素的预测性进行检验。根据各危险因素的截断值进行分层,通过Kaplan-Meier生存曲线分析比较各组预后差异。结果:共纳入63例患儿,男性30例,女性33例;年龄(5.6±4.0)岁;28 d死亡16例,病死率为25.4%。生存者与死亡组间性别、年龄、体重及病原菌分布差异无统计学意义。死亡组机械通气比例、外科干预比例、血管活性药物应用比例、前降钙素原、C-反应蛋白、活化部分凝血活酶时间、血乳酸(Lac)、Pv-aCO_(2)/Ca-vO_(2)、儿童序贯器官衰竭评分、儿科危重症死亡危险评分Ⅲ均较存活组明显升高,血小板计数、纤维蛋白原、平均动脉压较生存组明显降低,差异均具有统计学意义。通过多因素Logistic回归分析筛选出Lac及Pv-aCO_(2)/Ca-vO_(2)为影响患儿预后的独立危险因素〔优势比(OR)和95%可信区间(95%CI)分别为2.01(1.15~3.21)、2.37(1.41~3.22),均P<0.01〕。ROC曲线分析显示,Lac、Pv-aCO_(2)/Ca-vO_(2)及二者联合的曲线下面积(AUC)分别为0.745、0.876和0.923,敏感度分别为75%、85%和88%,特异度分别为71%、87%和91%。根据各危险因素的截断值分层,Kaplan-Meier生存曲线分析显示,Lac≥4 mmol/L组28 d累积生存率低于Lac<4 mmol/L组〔64.29%(18/28)比82.86%(29/35),P<0.05〕;Pv-aCO_(2)/Ca-vO_(2)≥1.6组28 d累积生�Objective To investigate the prognostic value of the ratio of veno-arterial carbon dioxide partial pressure difference to arterio-venous oxygen content difference(Pv-aCO_(2)/Ca-vO_(2))in children with primary peritonitis-related septic shock.Methods A retrospective study was conducted.Sixty-three children with primary peritonitis-related septic shock admitted to department of intensive care unit of the Children's Hospital Affiliated to Xi'an Jiaotong University from December 2016 to December 2021 were enrolled.The 28-day all-cause mortality was the primary endpoint event.The children were divided into survival group and death group according to the prognosis.The baseline data,blood gas analysis,blood routine,coagulation,inflammatory status,critical score and other related clinical data of the two groups were statistics.The factors affecting the prognosis were analyzed by binary Logistic regression,and the predictability of risk factors were tested by the receiver operator characteristic curve(ROC curve).The risk factors were stratified according to the cut-off,Kaplan-Meier survival curve analysis compared the prognostic differences between the groups.Results A total of 63 children were enrolled,including 30 males and 33 females,the average age(5.6±4.0)years old,16 cases died in 28 days,with mortality was 25.4%.There were no significant differences in gender,age,body weight and pathogen distribution between the two groups.The proportion of mechanical ventilation,surgical intervention,vasoactive drug application,and procalcitonin,C-reactive protein,activated partial thromboplastin time,serum lactate(Lac),Pv-aCO_(2)/Ca-vO_(2),pediatric sequential organ failure assessment,pediatric risk of mortalityⅢin the death group were higher than those in the survival group.Platelet count,fibrinogen,mean arterial pressure were lower than those in the survival group,and the differences were statistically significant.Binary Logistic regression analysis showed that Lac and Pv-aCO_(2)/Ca-vO_(2) were independent risk factors affec

关 键 词：脓毒症 腹膜炎 静脉-动脉血二氧化碳分压差与动脉-静脉血氧含量差比值 乳酸 

分 类 号：R725.7[医药卫生—儿科] R720.597[医药卫生—临床医学]