早期动态Pcv-aCO_(2)及Pcv-aCO_(2)/Ca-cvO_(2)监测对感染性休克患者预后评估的前瞻性临床研究  

A Prospective Clinical Study of Dynamic Pcv-aCO_(2)and Pcv-aCO_(2)/Ca-cvO_(2)Ratio Monitoring in Evaluating the Prognosis of Patients with Septic Shock

作　　者：孙新星 江坤 张珺[3] 王晓红[3] SUN Xinxing;JIANG Kun;ZHANG Jun;WANG Xiaohong(Ningxia Medical University,Yinchuan 750004,China;The First Affiliated Hospital of Nanyang Medical College,Nanyang 473000,China;Department of Intensive Care Unit,General Hospital of Ningxia Medical University,First Clinical Medical College of Ningxia Medical University,750004,Yinchuan,China)

机构地区：[1]宁夏医科大学,银川750004 [2]南阳医学高等专科学校第一附属医院,南阳473000 [3]宁夏医科大学总医院重症医学科,宁夏医科大学第一临床医学院,银川750004

出　　处：《宁夏医科大学学报》2024年第1期54-59,共6页Journal of Ningxia Medical University

基　　金：宁夏回族自治区重点研发计划项目(2021BEG03064)。

摘　　要：目的探究早期中心静脉与动脉二氧化碳分压差(Pcv-aCO_(2))、中心静脉与动脉二氧化碳分压差和动脉与中心静脉氧含量差的比值(Pcv-aCO_(2)/Ca-cvO_(2))在感染性休克的预后评估中的价值。方法选择2018年10月至2020年12月间在宁夏医科大学总医院ICU收住的感染性休克患者90例,动态记录患者入ICU后第1、2、3、5天中心静脉和外周动脉血气分析数据。随访患者28 d预后,依据生存情况分为存活组(58例)与死亡组(32例)。采用Logistic回归对感染性休克患者预后影响因素进行分析。采用受试者工作特征(ROC)曲线分析入院后24 h急性生理学和慢性健康状况评分系统II(APACHEⅡ)评分、乳酸和Pcv-aCO_(2)对患者预后的预测价值。结果感染性休克死亡组患者入ICU第2、3天的ScvO_(2)低于存活组(P<0.05)。第2、3天的Pcv-aCO_(2)高于存活组(P<0.05)。死亡组入ICU第1、2、3天的乳酸值均高于存活组(P均<0.05)。两组患者入ICU第5天ScvO_(2)、乳酸及Pcv-aCO_(2)的差异均无统计学意义(P均>0.05)。两组患者入ICU任何时相的Pcv-aCO_(2)/Ca-cvO_(2)值差异均无统计学意义(P均>0.05)。以感染性休克患者的预后为因变量的Logistic回归分析,Pcv-aCO_(2)第3天(OR=1.153,95%CI:1.005~1.323)、Pcv-aCO_(2)第3天(OR=1.369,95%CI:1.030~1.819)以及APACHEⅡ评分(OR=1.565,95%CI:1.285~1.906)是影响感染性休克患者死亡的独立危险因素(P<0.05)。ROC曲线分析可得Pcv-aCO_(2)(第3天)联合APACHE II评分对于感染性休克病人的死亡的预测价值高于其单独的预测价值(AUC=0.727,P<0.001)。结论早期Pcv-aCO_(2)、血乳酸、ScVO_(2)较Pcv-aCO_(2)/Ca-cvO_(2)更好反应感染性休克疾病严重程度和预后。持续升高的Pcv-aCO_(2)对感染性休克预后预测价值更大。Objective To investigate the value of central venous-arterial carbon dioxide partial pressure difference(Pcv-aCO_(2)),the ratio of central venous-arterial carbon dioxide partial pressure difference to arterial-central venous oxygen content difference(Pcv-aCO_(2)/Ca-cvO_(2))and lactate in the prognostic assessment of septic shock.Methods A total of 90 patients with septic shock admitted to the ICU of General Hospital of Ningxia Medical University from October 2018 to December 2020,and their general clinical data were recorded.The central venous and peripheral arterial blood gas analysis data were dynamically record on the first,second,third,and fifth day after the patient entered the ICU.After 28 days of follow-up,the patients were divided into survivors group(58 cases)and a non-survivors group(32 cases)based on their survival status.Logistic regression was used to analyze the prognostic factors of patients with septic shock.The predictive value of acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores,lactate,and Pcv-aCO_(2)were analyzed for prognosis at 24 h after admission using the receiver operating characteristic(ROC)curve.Results ScvO_(2)was significantly lower in the septic shock non-survivors group than in the survivors group on days 2 and 3 of admission to the ICU(P<0.05).Pcv-aCO_(2)was significantly higher than that in the survivors group on days 2 and 3 of admission to the ICU(P<0.05).The lactate values on days 1,2 and 3 of ICU admission were higher in the non-survivors group than those in the survivors group(P all<0.05).The levels of Pcv-aCO_(2)/Ca-cvO_(2)at any time point of ICU stay were not significantly different between the non-survivors group and survivors group(P all>0.05).The differences in ScvO_(2),lactate and Pcv-aCO_(2)on day 5 of admission to ICU were not statistically significant in both groups(P all>0.05).Univariate analysis and forward stepwise logistic regression analysis were performed using the 28-day mortality as the primary endpoint in septic shock patients.The findings

关 键 词：感染性休克 中心静脉与动脉二氧化碳分压差 乳酸 中心静脉与动脉二氧化碳分压差和动脉与中心静脉氧含量差的比值 

分 类 号：R605.971[医药卫生—急诊医学]