脓毒性休克患者血中一氧化碳含量的变化与APACHE Ⅱ评分的关系  

Relationship between changes of arterial carbon monoxide levels and APACHE Ⅱ score in patients with septic shock

作　　者：刘贵明[1] 丁学琴[1] 许国忠[1] 王俊科[1] 

机构地区：[1]中国医科大学附属第一医院麻醉科,沈阳110001

出　　处：《中华急诊医学杂志》2003年第6期403-405,共3页Chinese Journal of Emergency Medicine

摘　　要：目的　观察脓毒性休克患者血中一氧化碳含量的变化及其与APACHEⅡ评分的关系及意义。方法　选择ICU脓毒性休克患者 6 2例 ,在入ICU 2 4h内对每个患者进行APACHEⅡ评分 ,同时测动脉血中Hb和碳氧血红蛋白 (COHb)含量 ,按照预后分为死亡组 2 4例 ,存活组 38例。另选同期无感染行择期手术的患者为对照组 2 0例 ,测患者术前动脉血中Hb和COHb含量。结果　对照组血中Hb含量为 (1 35 1± 9 3)g/L ,脓毒性休克患者血中Hb含量较对照组略低 ,为 (1 2 6 3± 1 5 4 )g/L ,但差异无显著性。脓毒性休克患者血中COHb含量明显高于对照组 ,两组分别为 (2 1 9± 0 76 ) %和 (0 6 4± 0 31 ) % ,P <0 0 5。脓毒性休克患者APACHEⅡ各分段血中COHb含量与病死率随APACHEⅡ评分的增加而增加 ,COHb含量与APACHEⅡ评分呈显著正相关关系 (r =0 78,P <0 0 5 )。死亡组血中COHb含量及APACHEⅡ评分高于存活组。结论　内源性一氧化碳与脓毒性休克的病理机制密切相关 ,且与APACHEⅡ评分呈正相关关系 。Objective To investigate the relationship between changes of arterial carbon monoxide(CO)levels and APACHE Ⅱ score in patients with septic shock.Methods Arterial carboxyhemoglobin(COHb)levels,as an indicator of endogenous carbon monoxide production,were measured in 40 patients with septic shock in intensive care unit.A severity of illness score (APACHE Ⅱ)was determined for each patient during the first 24 h in the ICU,at the same time,arterial Hb and COHb were measured.All these patients were divided into two groups based on their prognosis:survival group( n =29)and death group ( n =11).The patients during the same period who did not have an infection were selected as normal group( n =20).Results There were no difference between arterial Hb levels in partients with septic shock and normal group,whereas,COHb levels in patients with septic shock were higher than normal group,(2 19±0 76)%vs(0 64±0 31)%, P <0 05.An increase in the APACHE Ⅱ score indicated a worsening of the patient ′s condition.There was a positive correlation between arterial COHb levels and the APACHE Ⅱ score ( r =0 78, P <0 05).An increase in arterial COHb levels was associated with an increase in the severity of illness.Arterial COHb levels of the death group was higher than that of the survival group ( P <0 05).Conclusion These findings support that endogenously produced CO may play an important role in the pathogenesis of septic shock,and may serves as an indicator to evaluate the paitent ′s condition and prognosis. [

关 键 词：脓毒性休克 一氧化碳 APACHEⅡ 碳氧血红蛋白 COHB 

分 类 号：R631.4[医药卫生—外科学]