早期PI联合Pv-aCO_(2)/Ca-vO_(2)预测老年脓毒性休克的死亡风险  

Value of early peripheral perfusion index combined with Pv-aCO_(2)/Ca-vO_(2) in assessing mortality risk in elderly patients with septic shock

作　　者：宫平 刘倩[1] 王啸 袁会敏 王维展[1] 王璞[1] Gong Ping;Liu Qian;Wang Xiao;Yuan Huimin;Wang Weizhan;Wang Pu(Emergency Intensive Care Unit,Harrison International Peace Hospital,Hebei Medical University,Hengshui 053000,China)

机构地区：[1]河北医科大学哈励逊国际和平医院急诊科,河北衡水053000

出　　处：《中华临床医师杂志（电子版）》2024年第3期253-258,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：河北省衡水市卫生科技计划项目(2019014057Z)。

摘　　要：目的探索老年脓毒性休克患者3 h初始复苏后外周灌注指数(PI)联合中心静脉-动脉二氧化碳分压差/动脉-中心静脉氧含量差(Pv-aCO_(2)/Ca-vO_(2))预测28 d死亡风险的价值。方法采用前瞻性研究,选取河北医科大学哈励逊国际和平医院EICU自2019年10月~2023年10月收治的老年脓毒性休克患者,完成3 h初始复苏时监测PI并行中心静脉及动脉血气分析计算PvaCO_(2)/Ca-vO_(2)。依据患者随访28 d预后情况,分为2组即生存组和死亡组,比较2组患者临床指标,应用二元logistic回归分析方法筛选出28 d死亡的单独预测指标,描绘PI、Pv-aCO_(2)/Ca-vO_(2)及两者联合的受试者工作特征曲线(ROC),MedCalc软件对比单独指标与联合指标对28 d预后的诊断效能。结果70例患者纳入研究,生存组34例、死亡组36例,2组入院一般情况比较差异无统计学意义(均P>0.05),28 d的病死率51.43%。3 h初始复苏后,生存组PI(1.56±0.50 vs 0.72±0.32)高于死亡组,Pv-aCO_(2)/Ca-vO_(2)[(1.58±0.56 vs 2.32±0.78)]低于死亡组,2组比较差异显著(P<0.001)。二元logistic回归分析结果PI(OR=0.004,95%CI:0~0.079,P<0.001)、Pv-aCO_(2)/Ca-vO_(2)(OR=11.520,95%CI:2.199~60.344,P=0.004)是脓毒性休克28 d死亡的独立预测因子。ROC分析显示,PI、Pv-aCO_(2)/Ca-vO_(2)及两者联合预测脓毒性休克患者28 d死亡的AUC分别为0.901、0.783和0.951,敏感度分别为97.2%、80.6%和91.7%,特异度分别为71.6%、67.6%和88.2%。ROC曲线下面积对比表明:PI与Pv-aCO_(2)/Ca-vO_(2)对28 d死亡预测效能差异无统计学意义(P=0.095),两者联合优于PI、Pv-aCO_(2)/Ca-vO_(2)单独预测价值(分别P=0.043、0.002)。结论脓毒性休克患者完成3 h初始复苏时PI、Pv-aCO_(2)/Ca-vO_(2)是28 d死亡的独立预测因子,两者联合诊断效能更佳。Objective To assess the predictive value of peripheral perfusion index(PI)combined with central venous-arterial carbon dioxide tension to arterial-venous oxygen content ratio(Pv-aCO_(2)/Ca-vO_(2))for prognosis after 3 h of initial resuscitation of septic shock.Methods This was a rospective study in which elderly patients with septic shock admitted to the Emergency Intensive Care Unit of Harison International Peace Hospital of Hebei Medical University from October 2019 to October 2023 were selected.After 3 h of initial resuscitation,PI was monitored and Pv-aCO_(2)/Ca-vO_(2) was calculated by central vein and arterial blood gas analysis.The patients were divided into either a survival group or a death group according to the 28-d survival status,and the differences in demographics and clinical data were compared between the two groups.Binary logistic regression analysis was used to screen out the independent predictors of 28-d death.Receiver operating characteristic(ROC)curve analysis of PI,Pv-aCO_(2)/Ca-vO_(2),and their combination was performed,and MedCalc software was used to compare the diagnostic efficacy of PI and Pv-aCO_(2)/CavSO_(2),either alone or in combination,for the prognosis at 28 d.Results A total of 70 patients were included in the study,including 34 patients in the survival group and 36 in the death group.There was no significant difference in general data at admission between the two groups(P>0.05 for all),and the 28-d fatality rate was 51.43%.After 3 h of initial resuscitation,PI(1.56±0.50 vs 0.72±0.32)was significantly higher and PvaCO_(2)/Ca-vO_(2)(1.58±0.56 vs 2.32±0.78)was significantly lower in the survival group than in the death group(P<0.001).Binary logistic regression analysis demonstrated that PI(odds ratio[OR]=0.004,95%confidence interval[CI]:0~0.079,P<0.001)and Pv-aCO_(2)/Ca-vO_(2)(OR=11.520,95%CI:2.199~60.344,P=0.004)were independent predictors of death at 28 d after septic shock.ROC analysis showed that the area under ROC curve(AUC)values of PI,Pv-aCO_(2)/Ca-vO_(2),and their comb

关 键 词：脓毒性休克 外周灌注指数 中心静脉-动脉二氧化碳分压差/动脉-中心静脉氧含量差 预后预测 

分 类 号：R459.7[医药卫生—急诊医学]