外科重症患者的氧代谢特点与监测

Characteristics and monitoring of oxygen metabolism in critical surgical patients

目的探讨外科重症患者的氧代谢特点,评估氧代谢监测的临床意义。方法126例外科重症患者,根据APACHEII伤情严重度评分分成重、较重和极重3组。动态监测动脉血氧分压(PaO_2)、动脉血乳酸(ABL)并计算氧合指数(OI=PaO_2/FiO_2)等指标,比较3组之间的差异。结果患者氧代谢水平在重症早期即发生异常,与疾病的严重程度相关;有效的治疗后动脉血氧分压、氧合指数上升显著,动脉血乳酸下降明显(P<0.01),治疗初期3组之间监测指标差异有统计学意义(P<0.01),痊愈前3组之间差异无统计学意义(P>0.05);死亡病例的乏氧代谢指标呈持续恶化趋势。结论氧代谢水平与外科重症患者的病情严重程度密切相关,动态监测乏氧代谢指标,对外科重症患者的病情转归有一定的预警作用。

Objective To investigate the changes of oxygen metabolism in critical surgical patients and to evaluate the clinical monitoring of oxygen metabolism. Methods 126 critical surgical patients were divided into three groups according to their acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ）. The partial arterial oxygen pressure （ PaO2 ） and arterial blood lactate （ABL） concentrations were dynamically monitored, and the oxygen index was recorded. All the data were compared among the three groups. Results Oxygen metabolism abnormality was found at earlier period, and it was correlated with APACHEII. PaO2 increased and ABL decreased significantly after effective therapy（ P 〈0. 01 ）. There were significant differences in PaO2 , ABL and oxygen index among the three groups in the early treatment （ P 〈 0.01 ）, but there was no significant difference before healing well （ P 〉 0.05）. Oxygen deficiency metabolic variables tended to deteriorate in the dead. Conclusions The level of oxygen metabolism is closely correlated with critical surgical patients＇ condition. Dynamic monitoring of oxygen metabolism index is valuable in predicting the outcome of patients.