神经重症患者四肢灌注指数与乳酸的相关性研究  

Correlation between four limbs perfusion index and lactic acid in patients with severe neurological diseases

作　　者：郭文[1] 马龙[1] 吐尔洪·吐尔逊[1] 李晓鹏[1] 刘波[1] 谢志毅[2] 于湘友[1] Guo Wen;Ma Long;Tuerhong·Tuerxun;Li Xiaopeng;Liu Bo;Xie Zhiyi;Yu Xiangyou(Department of Intensive Care Unit,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,Xinjiang Uygur Autonomous Region,China;Department of Critical Care Medicine,Beijing Tsinghua Changgung Hospital,Clinical School of Medicine of Tsinghua University,Beijing 102218,China)

机构地区：[1]新疆医科大学第一附属医院重症医学中心,乌鲁木齐830000 [2]清华大学附属北京清华长庚医院重症医学科,清华大学临床医学院,北京102218

出　　处：《中华危重病急救医学》2023年第5期509-512,共4页Chinese Critical Care Medicine

基　　金：自治区科技支疆项目(2021E02064)。

摘　　要：目的观察神经重症患者四肢灌注指数(PI)与血乳酸的相关性,并评价PI对患者微循环灌注代谢障碍的预测价值。方法采用前瞻性观察性研究方法,选择2020年7月1日至8月20日新疆医科大学第一附属医院神经重症监护病房(NICU)收治的成人患者进行研究。在室内温度控制在25℃的条件下,所有患者取平卧位,测量入NICU 24 h内及入NICU 24~48 h时的血压、心率、双侧食指与双侧拇趾的PI及动脉血乳酸。比较不同时间段四肢PI的差异,及其与乳酸的相关性。用受试者工作特征曲线(ROC曲线)评价四肢PI对患者微循环灌注代谢障碍的预测价值。结果共入选神经重症患者44例,其中男性28例,女性16例;平均年龄(61.2±16.5)岁。入NICU 24 h内左食指与右食指PI〔2.57(1.44,4.79)比2.70(1.25,5.33)〕、左拇趾与右拇趾PI〔2.09(0.85,4.76)比1.88(0.74,4.32)〕以及入NICU 24~48 h左食指与右食指PI〔3.17(1.49,5.07)比3.14(1.33,5.36)〕、左拇趾与右拇趾PI〔2.07(0.75,5.20)比2.07(0.68,4.67)〕差异均无统计学意义(均P>0.05);但同侧上下肢PI比较,除入NICU 24~48 h测量的左食指与左拇趾PI差异无统计学意义外(P>0.05),其余时间段拇趾PI均低于食指PI(均P<0.05)。相关性分析显示,两个时间段患者四肢PI均与动脉血乳酸呈显著负相关(入NICU 24 h内左食指、右食指、左拇趾、右拇趾r值分别为-0.549、-0.482、-0.392、-0.343,入NICU 24~48 h左食指、右食指、左拇趾、右拇趾r值分别为-0.331、-0.292、-0.402、-0.442,均P<0.05)。以乳酸≥2 mmol/L作为微循环灌注代谢障碍的诊断标准(共27次,占30.7%),比较四肢PI预测微循环灌注代谢障碍的效力。ROC曲线分析显示,左食指、右食指、左拇趾、右拇趾预测微循环灌注代谢障碍的曲线下面积(AUC)和95%可信区间(95%CI)分别为0.729(0.609~0.850)、0.767(0.662~0.871)、0.722(0.609~0.835)、0.718(0.593~0.842),两两比较AUC差异均无统计学意义(均P>0.05)。右食指PI�Objective To observe the correlation between the four limbs perfusion index(PI)and blood lactic acid in patients with neurosis,and evaluate the predictive value of PI on microcirculation perfusion metabolic disorder in patients with neurosis.Methods A prospective observational study was conducted.Adult patients admitted to the department of neurological intensive care unit(NICU)of the First Affiliated Hospital of Xinjiang Medical University from July 1 to August 20 in 2020 were enrolled.Under the condition of indoor temperature controlled at 25℃,all patients were placed in the supine position,and the blood pressure,heart rate,PI of both fingers and thumb toes and arterial blood lactic acid were measured within 24 hours and 24-48 hours after NICU.The difference of four limbs PI at different time periods and its correlation with lactic acid were compared.Receiver operator characteristic curve(ROC curve)was used to evaluate the predictive value of four limbs PI on patients with microcirculatory perfusion metabolic disorder.Results A total of 44 patients with neurosis were enrolled,including 28 males and 16 females;average age(61.2±16.5)years old.There were no significant differences in PI of the left index finger and the right index finger[2.57(1.44,4.79)vs.2.70(1.25,5.33)],PI of the left toe and the right toe[2.09(0.85,4.76)vs.1.88(0.74,4.32)]within 24 hours after entering the NICU,and the PI of the left index finger and the right index finger[3.17(1.49,5.07)vs.3.14(1.33,5.36)],PI of the left toe and the right toe[2.07(0.75,5.20)vs.2.07(0.68,4.67)]at 24-48 hours after NICU admission(all P>0.05).However,compared to the PI of the upper and lower limbs on the same side,except for the 24-48 hours after ICU of the PI difference between the left index finger and the left toe(P>0.05),the PI of the toe was lower than that of the index finger at the other time periods(all P<0.05).The correlation analysis showed that the PI value of four limbs of patients in both time periods were significantly negatively correlated with

关 键 词：灌注指数 乳酸 休克 血流动力学 

分 类 号：R741[医药卫生—神经病学与精神病学]