脓毒症患者穴位组织氧监测的临床观察

Application of monitoring tissue oxygen tension in Zusanli point in patients with sepsis

目的监测脓毒症患者足三里穴位组织氧变化,评估其局部组织氧合状态,探讨穴位组织氧测定法在临床中的应用价值。方法46例有创机械通气的危重症患者分为脓毒症组(24例)和对照组(22例)。利用国产二通道组织氧测定仪,测定吸氧浓度(FiO2)40%时右下肢足三里穴位组织氧分压(PtO2),同时检测动脉血气、体温、心率、血压、血红蛋白,计算PtO2指数(PtO2/PaO2比值)。结果与对照组比较,脓毒症组APACHEⅡ、体温、心率显著增高,PaO2显著降低;同时,脓毒症组PtO2指数、PtO2显著升高(P均<0.05)。结论脓毒症患者在全身氧输送障碍的情况下,穴位局部组织的氧需求显著增加;穴位组织可能通过显著提高PtO2指数,来满足自身异常增高的氧需求。用穴位组织氧测定法监测脓毒症患者局部组织氧合状况,有十分显著的意义。

Objective To evaluate the local tissue oxygenation of patients with sepsis,especially patients suffering from severe infections by monitoring the change of tissue oxygen in Zusanli point of these patients, and to discuss the value of acupoint tissue oxygen determination in clinical applications.Methods 46 critically ill patients under invasive positive pressure ventilation （IPPV）were divided into sepsis group（24 cases）and non-infection group （22 cases）.Use domestically made two-passage tissue oxygen tension determinator to determine the tissue oxygen tension （PtO2）in Zusanli point of the right lower limb when the fraction of inspired oxygen （FiO2） was at 40%.Meanwhile,the acute physiology and chronic health evaluation Ⅱ（APACHEⅡ）,the arterial blood gas （ABS）,body temperature, heart rate,blood pressure and hemoglobin were also tested,and PtO2 index （ratio of PtO2/PaO2） was calculated.Results APACHEⅡ,the heart rate and the body temperature were significantly higher,and PaO2 was significantly lower in the sepsis group than that in the non-infection group.On the contrary,the PtO2 index and PtO2 went up significantly, especially the PtO2 index （ all P〈0.05 ） in the sepsis group.Conclusion When the patients with sepsis are unable to receive systemic oxygen delivery,the oxygen demand of acupoints in local tissues is still increased significantly. The acupoint tissue may satisfy its own abnormally increased oxygen demand through significant improvement of the PtO2 index.It is of great significance to use the acupoint tissue oxygen determination method to determine the local tissue oxygenation state of the patients with sepsis.