经皮氧分压/经皮二氧化碳分压比值联合乳酸检测对脓毒性休克患者预后的评估价值

Evaluation value of transcutaneous oxygen partial pressure/percutaneous nitrogen dioxide partial pressure ratio combined with lactic acid in evaluating the prognosis of patients with septic shock

目的探讨经皮氧分压/经皮二氧化碳分压比值(PtcO_(2)/PtcCO_(2))、乳酸(Lac)单独及联合检测对脓毒性休克患者预后的评估价值。方法收集2018年1月~2020年8月在我院治疗的脓毒性休克患者103例,根据28 d生存状况将其分为存活组(80例)和死亡组(23例)。比较两组患者的一般资料、临床资料、接受治疗的情况及液体复苏前后的血流动力学、氧代谢参数。采用Cox多因素回归分析探讨液体复苏前后影响脓毒性休克患者死亡的相关因素,采用受试者工作特征(ROC)曲线评估不同因素预测患者死亡的价值。结果死亡组序贯器官衰竭(SOFA)评分、急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分、血肌酐水平、机械通气和肾脏替代治疗患者比例、6 h补液量均高于存活组,6 h血肌酐清除率和液体复苏成功率均低于存活组(P<0.05)。液体复苏后死亡组平均动脉压(MAP)、氧合指数(PaO_(2)/FiO_(2))和PtcO_(2)/PtcCO_(2)均低于存活组,中心静脉压(CVP)和Lac水平均高于存活组(P<0.05)。Cox多因素回归分析结果显示,液体复苏前后Lac和PtcO_(2)/PtcCO_(2)均与患者死亡相关,Lac为患者死亡的独立危险因素,PtcO_(2)/PtcCO_(2)为其独立保护因素(P<0.05)。液体复苏前后Lac和PtcO_(2)/PtcCO_(2)二者联合检测的ROC曲线下面积(AUC)均高于同期二者单独检测,液体复苏后二者联合检测的AUC高于复苏前(P<0.05)。结论液体复苏前后Lac和PtcO_(2)/PtcCO_(2)分别为脓毒性休克的独立危险因素和独立保护因素,液体复苏后Lac和PtcO_(2)/PtcCO_(2)的联合检测对脓毒症预后的预测更具有临床价值。

Objective To investigate the value of transcutaneous oxygen partial pressure/percutaneous nitrogen dioxide partial pressure ratio(PtcO_(2)/PtcCO_(2))and lactic acid(Lac)alone and combination in evaluating the prognosis of patients with septic shock.Methods A total of 103 patients with septic shock who were treated in our hospital from January 2018 to August 2020 were collected and divided into survival group(80 cases)and death group(23 cases)according to their 28 d survival status.The general data,hemodynamic indexes,medical treatment,parameters of hemodynamics and oxygen metabolism before and after fluid resuscitation were compared between the two groups.Cox multivariate regression analysis was used to investigate the factors influencing the death of with sepsis shock patients before and after fluid resuscitation,and receiver operating characteristic(ROC)curve was used to evaluate the predictive value of death.Results Sequential Organ Failure Assessment(SOFA)score,Acute Physiology and Chronic Health EvaluationⅡ(APACEⅡ)score,serum creatinine level,the proportion of patients with mechanical ventilation and renal replacement therapy,while 6 h fluid intake in death group were higher than those in survival group,while 6 h serum creatinine clearance rate and success rate of resuscitation were lower than those in survival group(P<0.05).After resuscitation,mean artery pressure(MAP),oxygenation index(PaO_(2)/FiO_(2))and PtcO_(2)/PtcCO_(2)in the death group were lower than those in survival group,central venous pressure(CVP)and Lac levels were higher than those in survival group(P<0.05).Cox multivariate regression analysis showed that Lac and PtcO_(2)/PtcCO_(2)were both associated with death before and after fluid resuscitation,Lac was an independent risk factor for death,and PtcO_(2)/PtcCO_(2)was an independent protective factor for death(P<0.05).The area under ROC curve(AUC)of Lac and PtcO_(2)/PtcCO_(2)combined test was higher than that of Lac and PtcO_(2)alone test before and after fluid resuscitation,and the AUC of PtcO_(2)combined test after fluid resuscitation was higher than that before fluid resuscitation(P<0.05).Conclusion Lac and PtcO_(2)/PtcCO_(2)before and after fluid resuscitation are independent risk factors and independent protective factors for septic shock,respectively.Combined detection of Lac and PtcO_(2)/PtcCO_(2)after resuscitation have more clinical value in predicting the prognosis of sepsis.