强离子隙与创伤失血性休克患者预后的相关性  

Correlation study between strong ion gap and the prognosis of traumatic hemorrhagic shock

作　　者：陈明迪 王思盼 张珏 张珂 陆士奇[2] 李毅[2] Chen Ming-di;Wang Si-pan;Zhang Jue;Zhang Ke;Lu Shi-qi;Li Yi(Intensive Care Unit,Jingjiang People′s Hospital,Jingjiang 214500,China)

机构地区：[1]靖江市人民医院重症医学科,江苏靖江214500 [2]苏州大学附属第一医院重症医学科,江苏苏州215006

出　　处：《中国急救医学》2023年第4期258-261,共4页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学青年科学基金项目(81701213);江苏省高等学校自然科学面上项目(20KJB320026);苏州市科技计划项目(SYS2019055)。

摘　　要：目的探讨强离子隙(strong ion gap,SIG)对创伤失血性休克患者预后的评估价值。方法收集2017年9月至2020年8月在苏州大学附属第一医院急诊科和重症医学科收治的创伤失血性休克患者101例,根据患者预后情况分为死亡组和生存组。收集患者的基本临床资料,并于入院当时和入院后6 h、12 h、24 h检测SIG、阴离子隙(anion gap,AG)、乳酸、HCO_(3)^(-)、pH等,比较两组指标间的差异,并绘制受试者工作特征(ROC)曲线评估各指标对创伤失血性休克患者发生死亡风险的预测价值。结果与生存组比较,死亡组SIG和乳酸在入院后6 h明显升高,而AG和HCO_(3)^(-)则分别在入院后12 h和24 h才明显升高,两组差异有统计学意义(P<0.05)。ROC曲线分析显示,6 h SIG的曲线下面积(AUC)为0.885(95%CI 0.805~0.965),略大于6 h乳酸的AUC(0.836,95%CI 0.724~0.947),差异无统计学意义(P>0.05),但明显大于12 h AG的AUC(0.722,95%CI 0.604~0.841)和24 h HCO_(3)^(-)的AUC(0.749,95%CI 0.653~0.845),差异有统计学意义(P<0.05)。结论创伤失血性休克患者早期SIG即可升高,与其他酸碱紊乱指标比较,SIG是创伤失血性休克住院患者死亡的有效预测指标。Objective To investigate the value of strong ion gap(SIG)for predicting the mortality in the patients with traumatic hemorrhagic shock.Methods A total of 101 patients with traumatic hemorrhagic shock admitted to the Emergency Department and Intensive Care Unit of the First Affiliated Hospital of Soochow University were enrolled from September 2017 to August 2020.The patients were divided into the death group and the survival group according to the prognosis.General clinical data were collected and SIG,anion gap(AG),lactate,HCO_(3)^(-)and pH were compared at 0 h,6 h,12 h and 24 h after admission between the two groups.Receiver operating characteristic(ROC)curves were plotted to evaluate various indicators′predictive value of the prognosis in the patients with traumatic hemorrhagic shock.Results Compared with the survival group,the level of SIG and lactate of the death group were significantly increased at 6 h after admission,and the level of AG and HCO_(3)^(-)were significantly increased at 12 and 24 h after admission,respectively(P<0.05).There was no statistical difference in the area under ROC curve(AUC)between 6 h SIG(0.885,95%CI 0.805-0.965)and 6 h lactate(0.836,95%CI 0.724-0.947)(P>0.05),but the AUC of 6 h SIG was significantly bigger than that of 12 h AG(0.722,95%CI 0.604-0.841)and 24 h HCO_(3)^(-)(0.749,95%CI 0.653-0.845)(P<0.05).Conclusions SIG can be elevated at the early stage in the patients with traumatic hemorrhagic shock.Compared with other acid-base disturbance indexes,SIG may be a valid predictor of the mortality in hospitalized patients with traumatic hemorrhagic shock.

关 键 词：创伤 失血性休克 强离子隙 预后 

分 类 号：R605.971[医药卫生—急诊医学]