严重脓毒症患者液体复苏中ScvO_(2)、乳酸清除率与超声测算IVC-RVI的相关性及对预后的预测价值  

Correlation of ScvO_(2),lactate clearance rate,and ultrasound-measured IVC-RVI during fluid resuscitation in patients with severe sepsis and their predictive value for prognosis

作　　者：谭小飞[1] 刘扬[1] 王佳梅[1] 周传正[1] Tan Xiaofei;Liu Yang;Wang Jiamei;Zhou Chuanzheng(Department of Critical Care Medicine,Zigong First People’s Hospital,Zigong 643000,China)

机构地区：[1]四川省自贡市第一人民医院重症医学科,自贡643000

出　　处：《广西医科大学学报》2023年第9期1515-1521,共7页Journal of Guangxi Medical University

基　　金：2020年四川省医学(青年创新)科研课题资助项目(No.S20020)。

摘　　要：目的:探讨严重脓毒症患者液体复苏中中心静脉血氧饱和度(ScvO_(2))、乳酸清除率与超声测算下腔静脉呼吸变异度(IVC-RVI)的相关性,以期为临床早期制定干预方案提供参考。方法:选取2020年12月至2022年12月四川省自贡市第一人民医院60例严重脓毒症患者,对所有患者根据早期目标导向治疗(EGDT)方案按6 h脓毒症集束化治疗行液体复苏,监测ScvO_(2)、乳酸清除率,并经超声检查测算IVC-RVI,分析ScvO_(2)、乳酸清除率及IVC-RVI与EGDT治疗达标的关系,比较不同预后患者复苏后6 h、12 h及24 h ScvO_(2)、乳酸清除率及IVC-RVI,分析其对预后评估价值。结果:EGDT治疗未达标组复苏后6 h ScvO_(2)、乳酸清除率均低于达标组,IVC-RVI高于达标组(P<0.05);复苏后6 h ScvO_(2)、乳酸清除率低水平组患者EGDT治疗不达标风险分别是高水平组的7.500倍、4.667倍;IVC-RVI高水平组患者EGDT治疗不达标风险是低水平组的3.250倍;死亡组患者复苏后6 h、12 h及24 h ScvO_(2)、乳酸清除率均低于生存组患者,IVC-RVI高于生存组患者(P<0.05);复苏后6 h、12 h及24 h ScvO_(2)、乳酸清除率、IVC-RVI联合预测AUC分别为0.856、0.892、0.933,明显较各时间点单个指标大,且复苏后24 h联合预测AUC>复苏后12 h>复苏后6 h(P<0.05);严重脓毒症患者复苏后6 h、12 h及24 h ScvO_(2)、乳酸清除率均与IVC-RVI呈负相关关系(P<0.05)。结论:严重脓毒症患者液体复苏中ScvO_(2)、乳酸清除率及IVC-RVI对于液体复苏疗效具有较高评估价值,可为临床早期预测预后提供依据,以针对性展开后续治疗,提高患者生存率。Objective:To investigate the correlation between central venous oxygen saturation(ScvO_(2)),lactic acid clearance rate,and the variation of inferior vena cava respiration(IVC-RVI)measured by ultrasound in patients with severe sepsis during fluid resuscitation,so as to provide reference for early clinical intervention.Methods:A total of 60 patients with severe sepsis were selected from Zigong First People’s Hospital from December 2020 to December 2022.All patients were treated with fluid resuscitation according to early goal-directed therapy(EGDT)and 6-h sepsis bunging therapy.ScvO_(2)and lactate clearance rate was monitored,and IVC-RVI was calculated by ultrasound examination.The relationship between ScvO_(2),lactate clearance rate,IVC-RVI and EGDT treatment standard was analyzed.ScvO_(2),lactate clearance rate and IVC-RVI were compared at 6 h,12 h and 24 h after resuscitation in patients with different prognosis to analyze their prognostic evaluation value.Results:At 6 h after resuscitation,the ScvO_(2)and lactate clearance rate of the non-conforming group were lower than those of the conforming group,while the IVC-RVI was higher than that of the conforming group(P<0.05).The risk of substandard EGDT treatment in patients with low ScvO_(2)and lactate clearance at 6 h after resuscitation was 7.500 times and 4.667 times higher than that in patients with high level,respectively.The risk of substandard EGDT treatment in patients with high level of IVCRVI was 3.250 times higher than that in patients with low level.The ScvO_(2)and lactate clearance rate in death patients was lower than that in survival patients at 6 h,12 h and 24 h after resuscitation,while the IVC-RVI was higher than that in survival patients(P<0.05).The combined prediction AUC of ScvO_(2),lactate clearance rate and IVC-RVI at 6 h,12 h and 24 h after resuscitation was 0.856,0.892 and 0.933,respectively,which was significantly larger than the single index at each time point,and the combined prediction AUC at 24 h after resuscitation was>12 h>6 h afte

关 键 词：严重脓毒症 液体复苏 中心静脉血氧饱和度 乳酸清除率 下腔静脉呼吸变异度 预后 

分 类 号：R631.2[医药卫生—外科学]