危重病患者足三里穴内组织氧监测的临床观察

Clinical Monitoring of Tissue Oxygen Pressure on Acupoint Zusanli (ST36) of Patients in Critical Condition

目的探讨危重症患者足三里局部组织氧合状况,评估经穴组织氧测定法临床应用价值。方法将36例有创机械通气危重症患者分为感染组(13例)和非感染组(23例),用组织氧测定仪测定吸氧浓度(Fi O2)40%、100%时右侧足三里穴内组织氧分压(PtO2),同时检测动脉血氧分压(PaO2),计算PtO2指数(PtO2/PaO2比值)。结果PtO2与PaO2呈正相关(P<0·05);与非感染组比较,感染组PaO2显著降低,PtO2指数、PtO2显著升高(均P<0·05);Fi O2由40%调至100%后,感染组PtO2上升幅度显著大于非感染组(P<0·05)。结论重症感染者在全身性氧输送障碍时,经穴局部组织氧需求显著增加,组织氧供依赖性增强;经穴组织可能通过提高PtO2指数来满足自身氧需求。本法监测危重症局部组织氧合临床意义显著。

Objective To observe the local tissue oxygenation in acupoint Zusanli （ST36） of patients in critical condition, and to assess the value of applying tissue oxygen measurement via acupoint in clinical practice. Methods Thirty-six patients with severe illness undergoing invasive positive pressure ventilation （IPPV） were divided into the infected group （n = 13） and the non-infected group （n = 23）. Tissue oxygen pressure （PtO2） in the right acupoint Zusanli was measured with tissue oxygen tension detector when the concentration of inspired oxygen （FiO2） was 40 96 and 100 96 respectively, meanwhile, the arterial blood oxygen pressure （PaO2） was also determined to calculate PtO2 index （the ratio of PtO2/PaO2）. Results There was a positive correlation between PtO2 and PaO2 （P 〈 0.05） ; PaO2 in the infected group was lower, and PtO2 index and PtO2 were higher significantly, as compared with those in the non-infected group （all P〈0.05）. As FiO2 adjusted from 40% to 10096, the increment of PtO2 in the infected group was significantly higher than that in the non-infected group （P 〈 0.05）. Conclusion For the severely infected patients with obstacle of systemic oxygen delivery, the local tissue oxygen demand of acupoints increases significantly, and the tissue oxygen delivery dependence is enhanced, in this time, the tissue might fulfill the oxygen demand itself through elevating PtO2 index. It is of great significance to monitor tissue oxygen pressure in acupoint to determine the state of local tissue oxygenation in critically illed patients.