胃黏膜灌注指标评估普外科高危病人预后的价值

Parameters used to assess gut perfusion in high-risk patients after abdominal operation

目的:将空气胃张力测定仪测得的胃黏膜灌注指标:胃黏膜-动脉二氧化碳分压差(Pg-aCO2)、胃黏膜二氧化碳分压(PgCO2)和胃黏膜内pH值(pHi);用于普外科高危病人预后的评估;分析其临床应用价值。方法:用前瞻法临床研究外科加强医疗病区(SICU)42例腹部外科高危病人,记录入SICU后24h内的胃黏膜灌注指标、血流动力学、血乳酸,比较存活组和死亡组资料。结果:存活组和死亡组病人入病区后24h内Pg-aCO2有显著性差异[(7.60±6.10)mmHg比(13.20±8.40)mmHg,P<0.05];pHi、血乳酸水平有极显著差异[(7.38±0.09)mmol/L比(7.25±0.07)mmol/L,(1.90±1.10)mmol/L比(3.40±1.70)mmol/L,P<0.01]。用Logistic回归筛选出与病人预后独立相关因素为pHi,并求得Logistic回归方程:P=1/[1+e-(143.601-19.7551pHi)]。结论:Pg-aCO2和pHi、血乳酸一样可作为早期评估复苏效果的良好指标;其中pHi可早期独立预测危重病人的预后。

Objective To assess by air tonometry the value of newer parameters as gastric intramucosal-arterial PCO2,(Pg-aCO2), gastric intramucosal PCO2(PgCO2) and gastric intramucosal pH (pHi) in high-risk cases after abdominal operation. Methods Forty-two high-risk patients admitted to the SICU were prospectively studied. Parameters used to assess gut perfusion, hemodynamics and blood lactate were measured 24 hours after admission. The results were analyzed in terms of survivors versus nonsurvivors. Results Significant difference existed regarding pHi, blood lactate [(7.38±0.09) vs (7.25±0.07)]mmol/L, (1.90±1.10) mmol/L vs (3.40±1.70) mmol/L, P<0.01) and Pg-aCO2 [(7.60±6.10) mmHg vs (13.2±8.4) mmHg, P<0.05) between survivors and nonsurvivors, but pHi was the only variable that predicts the outcome independently, that was determined by Logistic regression. An equation is derived by means of logistic regression: P=1/[1+e-(143.601-19.7551PHi)]. Conclusions Pg-aCO2, PHi, and blood lactate are all reliable predictors of the prognosis after major abdominal operation, but pHi is the only variable that predicts the outcome independently.