脓毒症患者氧利用率的变化与预后关系

Relationship between prognosis and alteration of oxygen utilization coefficient in patients with sepsis

目的：探讨脓毒症患者氧利用率（O2UC）的变化与预后关系。方法：60例危重病患者分为脓毒症组30例和非脓毒症组30例；另设30例正常人作为正常对照组。脓毒症组和非脓毒症组患者于急诊人院时及住院后1、2、3、5、7和10d晨8时抽取股动脉和股静脉或锁骨下静脉血2ml，查血气并计算O2UC。正常对照组仅查动、静脉血气1次，并计算O2UC（为动-静脉血氧饱和度差／动脉血氧饱和度）。结果：患者急诊入院时和住院后1d，脓毒症组和非脓毒症组O2UC均显著高于正常对照组（P均〈0．01），而脓毒症组和非脓毒症组间差异无显著性（P〉0．05）。当O2UC持续高于55％达12～24h，患者预后极差，易于短期内死亡。从住院后2d起，脓毒症组和非脓毒症组O2UC均很快下降，并低于正常对照组，且脓毒症组较非脓毒症组下降更加明显（P均〈0．05）。非脓毒症组于住院后5d起O2UC逐渐回升，并恢复至正常。而脓毒症组患者于住院后2d起O2UC始终明显低于正常对照组（P均〈0．01）。当O2UC持续低于21％时，提示合并症较多，预后不佳。结论：脓毒症患者常存在较低的O2UC，且病情严重、预后差。O2UC可作为脓毒症患者判断组织缺氧、病情严重程度和评估预后的有效指标。

Objective： To investigate the relationship between prognosis and alteration of oxygen utilization coefficient （O2UC） in patients with sepsis. Methods： Sixty critically ill patients were divided into sepsis （n= 30） and non-sepsis （n= 30） groups, and 30 healthy controls were selected as normal control group. Gas analysis of arterial blood and central venous blood and calculation of O2UC （O2UC = arterial oxygen saturation-venous oxygen saturation/arterial oxygen saturation） were carried out at 8 o＇clock in sepsis and non-sepsis groups on admission and 1, 2, 3, 5, 7 and 10 days after admission, and gas analysis of arterial blood and central venous blood was carried out only once in the controls. Results： On admission and 1 day after admission, O2UCs in sepsis and non-sepsis groups were significantly higher than that of control group （both P〈0. 01）, but O2UC in sepsis group was not significantly different from that in non-sepsis group （P〉0. 05）. When O2UC in critically ill patients persisted higher than 55 % for 12-24 hours, the prognosis of the patients was poor and had a tendency to die in a short time. From the 2 nd day after admission, O2UCs in sepsis and non-sepsis groups were lower than that in control group, and O2UC in sepsis group was obviously lower than that in non-sepsis group （all P〈0.05）. From the 5 th day after admission, O2UC in non-sepsis group elevated gradually and was not significantly different from that in control group （all P〉0. 05）, but from the 2 nd day after admission, O2UC in sepsis group remained at a lower level compared with that in control group （all P〈0. 01）. When O2UC in patients with sepsis persisted below 21% and maintained for a long time, there were more complications, higher mortality and poor prognosis in the patients. Conclusion： O2UC in patients with sepsis is frequently lower, by which a more severe disease with poor prognosis can be predicted. O2UC is an effective, sensitive and convenient predictor in monitoring and treating patients with sepsis.