中心到外周的体温梯度和毛细血管再充盈时间对患者术中组织灌注的预测价值  

Predictive value of temperature gradient from center to periphery and capillary refilling time on tissue perfusion in patients during operation

作　　者：钱刚 周海军[2] 徐珂嘉 沈石文 QIAN Gang;ZHOU Haijun;XU Kejia;SHEN Shiwen(Department of Anesthesiology,Shanghai Changning Maternity and Infant Health Hospital,East China Normal University,Shanghai200050,China;Department of Anesthesiology,Tongren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai200336,China)

机构地区：[1]华东师范大学附属长宁区妇幼保健院麻醉科,上海200050 [2]上海交通大学医学院附属同仁医院麻醉科,上海200336

出　　处：《中国医药导报》2024年第21期106-111,共6页China Medical Herald

基　　金：国家自然科学基金青年科学基金资助项目(82302441);上海市长宁区卫生健康委员会麻醉与重症医学硕博士创新人才基地项目(RCJD2021S02);上海市长宁区妇幼保健院科研启动基金项目(2024Y-11)

摘　　要：目的探讨中心到外周的体温梯度(Tc-toe)和毛细血管再充盈时间(CRT)对患者术中组织灌注的预测价值。方法采用回顾性病例对照研究方法,选取2023年4月至7月于上海交通大学医学院附属同仁医院外科重症监护室收治的148例患者为研究对象,按照乳酸水平是否异常将其分为对照组(91例,乳酸水平<2.0 mmol/L)和病例组(57例,乳酸水平≥2.0 mmol/L)。比较两组相关指标。将乳酸作为因变量,将单因素分析结果中P<0.2的因素进行多因素logistic回归分析。受试者操作特征(ROC)曲线评估患者术中组织灌注的预测价值。结果两组手术时间、术中失血量、Tc-toe、CRT、意识和急诊手术情况比较,差异有统计学意义(P<0.05)。单因素logistic回归分析显示,Tc-toe、CRT、年龄、意识、术中失血量和急诊手术与乳酸水平有关(P<0.05)。多因素logistic回归分析显示,Tc-toe(OR=5.97,95%CI:1.55~23.04,P<0.05)、CRT(OR=38.48,95%CI:7.68~192.78,P<0.05)、肌酐(OR=0.07,95%CI:0.01~0.79,P<0.05)和冠心病/心律失常(OR=0.15,95%CI:0.03~0.83,P<0.05)是患者术中组织灌注的独立影响因素。ROC曲线分析显示,Tc-toe预测组织灌注的曲线下面积为0.876,截断值为1.05℃,灵敏度为80.22%,特异度为87.72%;CRT预测组织灌注的曲线下面积为0.919,截断值为2.5 s,灵敏度为74.73%,特异度为96.49%。结论Tc-toe和CRT可通过预测血乳酸水平,从而预测患者术中组织灌注情况。Objective To explore the predictive value of temperature gradient from center to periphery(Tc-toe)and capillary refilling time(CRT)on tissue perfusion in patients during operation.Methods A retrospective case-control study method was used to select 148 patients admitted to Surgical Intensive Care Unit of Tongren Hospital,Shanghai Jiao Tong University School of Medicine from April to July 2023.They were divided into the control group(91 cases,lactic acid level<2.0 mmol/L)and the case group(57 cases,lactic acid level≥2.0 mmol/L)based on whether their lactic acid levels were abnormal.Relevant indicators of the two groups were compared.Lactic acid as the dependent variable,multivariate logistic regression analysis was performed on the factors with P<0.2 from univariate analysis results.Receiver operator characteristic(ROC)curve was used to evaluate the predictive value of intraoperative tissue perfusion in patients.Results There were statistically significant differences in surgical time,intraoperative blood loss,Tc-toe,CRT,consciousness and emergency surgery between the two groups(P<0.05).Univariate logistic regression analysis showed that Tc-toe,CRT,age,consciousness,intraoperative blood loss,and emergency surgery were related to lactate levels(P<0.05).Multivariate logistic regression analysis showed that Tc-toe(OR=5.97,95%CI:1.55-23.04,P<0.05),CRT(OR=38.48,95%CI:7.68-192.78,P<0.05),creatinine(OR=0.07,95%CI:0.01-0.79,P<0.05),and coronary heart disease/arrhythmia(OR=0.15,95%CI:0.03-0.83,P<0.05)were independent influencing factors for intraoperative tissue perfusion in patients.ROC curve analysis showed that area under the curve for Tc-toe prediction of tissue perfusion was 0.876,the cut-off value of Tc-toe was 1.05℃,the sensitivity of Tc-toe was 80.22%,and the specificity of Tc-toe was 87.72%;area under the curve for CRT prediction of tissue perfusion was 0.919,the cut-off value of CRT was 2.5 s,the sensitivity of CRT was 74.73%,and the specificity of CRT was 96.49%.Conclusion Tc-toe and CRT can predict intraope

关 键 词：体温梯度 毛细血管再充盈时间 灌注 

分 类 号：R619[医药卫生—外科学]