Pcv-aCO_(2)/Ca-vO_(2)联合乳酸清除率评估脓毒症病情和预后的研究  

Evaluation of the septic severity and prognosis by the combination of the partial pressure of carbon dioxide/oxygen content difference of venous and arterial with lactate clearance

作　　者：马春霞 刘莉 雷震 阚天燕[1] 刘辉[1] 王玉巧[1] 高小芳 MA Chunxia;LIU Li;LEI Zhen;KAN Tianyan;LIU Hui;WANG Yuqiao;GAO Xiaofang(Intensive Care Unit,People′s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China)

机构地区：[1]宁夏回族自治区人民医院重症医学科,宁夏银川750002

出　　处：《宁夏医学杂志》2024年第4期290-294,共5页Ningxia Medical Journal

基　　金：宁夏自然科学基金项目(2022AAC03371,2022AAC03373);宁夏医科大学校级科研基金项目(XM2022068)。

摘　　要：目的分析脓毒症复苏过程中,中心静脉与动脉二氧化碳分压差和动脉静脉氧含量差的比值(Pcv-aCO_(2)/Ca-vO_(2))联合乳酸清除率(LCR)与病情严重程度及预后的关系,探讨Pcv-aCO_(2)/Ca-vO_(2)联合LCR对病情及预后的评估价值。方法92例脓毒症患者于入科和复苏6h后实施中心静脉和动脉血气分析,计算Pcv-aCO_(2)/Ca-vO_(2)和LCR值。依据复苏6h后Pcv-aCO_(2)/Ca-vO_(2)和LCR值分为3组,A组(Pcv-aCO_(2)/Ca-vO_(2)<1.4和LCR≥10%)38例,B组(Pcv-aCO_(2)/Ca-vO_(2)<1.4和LCR<10%)36例,C组(Pcv-aCO_(2)/Ca-vO_(2)≥1.4)18例,比较3组患者一般情况、病情危重程度及预后指标,进行相关性分析,绘制ROC曲线评估预后。结果3组患者急性生理和慢性健康评估系统(APACHEⅡ)评分、入科及复苏6 h后心率、入科胆红素及肌酐水平比较差异有统计学意义(P<0.05)。C组和B组患者序贯器官衰竭(SOFA)评分、入科及复苏6 h后去甲肾上腺素用量、机械通气使用率高于A组(P<0.05);C组与B组患者血小板水平低于A组(P<0.05)。C组28 d死亡率高于A组和B组(P<0.05)。复苏6 h后Pcv-aCO_(2)/Ca-vO_(2)联合LCR与APACHEⅡ评分及SOFA评分呈正相关(P<0.05)。结论Pcv-aCO_(2)/Ca-vO_(2)联合LCR能够评估脓毒症病情及预后。Objective To analyze the relationship of the partial pressure of carbon dioxide/oxygen content difference of venous and arterial(Pcv-aCO_(2)/Ca-vO_(2))with lactate clearance(LCR)during resuscitation,and to explore the value of Pcv-aCO_(2)/Ca-vO_(2)combined with LCR in evaluating the severity and prognosis of sepsis.Methods 92 patients with sepsis underwent central venous and arterial blood gas analysis at admission and 6h after resuscitation.Pcv-aCO_(2)/Ca-vO_(2)and LCR were calculated.According to Pcv-aCO_(2)/Ca-vO_(2)and LCR values,the patient were divided into three groups:group A(Pcv-aCO_(2)/Ca-vO_(2)<1.4 and LCR≥10%,n=38),Group B(Pcv-aCO_(2)/Ca-vO_(2)<1.4 and LCR<10%,n=36),Group C(Pcv-aCO_(2)/Ca-vO_(2)≥1.4,n=18).The general conditions,severity of disease and prognostic indicators of the three groups were compared,and the correlation analysis was performed.ROC curve was drawn to predict the prognosis.Results There were statistically significant differences(P<0.05)in the acute physiological and chronic health assessment system(APACHEII)scores,heart rate at admission and 6 hours after resuscitation,the levels of bilirubin and creatinine after admission among the three groups.The sequential organ failure assessment(SOFA),the dosage of norepinephrine at admission and 6 hours after resuscitation and the utilization rate of mechanical ventilation in group C and group B were significantly higher than those in group A(P<0.05).The platelet levels of patients in group C and group B were significantly lower than those in group A(P<0.05).The 28-day mortality rate in group C was higher than that in group A and group B(P<0.05).Pcv-aCO_(2)/Ca-vO_(2)6 hours after resuscitation combined with LCR was positively correlated with APACHEII score and SOFA score(P<0.05).Conclusion The combination of Pcv-aCO_(2)/Ca-vO_(2)and LCR can evaluate the severity and prognosis of sepsis.

关 键 词：脓毒症 中心静脉与动脉二氧化碳分压差和动脉与静脉氧含量差的比值 乳酸清除率 预后 

分 类 号：R714.62[医药卫生—妇产科学]