早期动脉血气分析对脓毒症患者预后的预测价值

Predictive Value of Early Arterial Blood Gas Analysis in Prognosis of Sepsis Patients

目的分析脓毒症患者早期动脉血气分析指标,探讨其与预后的关系。方法前瞻性观察2007年6月—2009年3月我院急诊监护室(EICU)救治的436例脓毒症患者的临床资料,按照来诊后第一次动脉血气分析结果判断是否存在低氧血症、酸中毒和高乳酸血症等,并根据判断结果对患者进行分组,比较各组患者28d病死率。结果436例脓毒症患者28d内共死亡86例,病死率19.7%。以动脉血氧分压(PaO2)60mmHg为标准分为非低氧血症组和低氧血症组,两组病死率分别为13.4%(41/307)和34.9%(45/129),组间比较差异有统计学意义〔RR=2.61,95%CI为(1.81,3.76),χ2=26.59,P<0.05〕;按照动脉血乳酸值2、4、9mmol/L为标准分组,4组患者病死率分别为5.4%(12/224)、17.0%(18/106)、41.5%(27/65)和70.7%(29/41),患者的病死率随着乳酸值的升高而增加(Pearson列联系数=0.45,χ2=108.41,P<0.05);按照是否存在酸中毒,分为酸中毒组和非酸中毒组,两组病死率分别为36.7%(80/218)和2.8%(6/218),组间比较差异有统计学意义〔RR=13.33,95%CI为(7.54,23.6),χ2=79.31,P<0.05〕;按照酸中毒类型分为代谢性酸中毒亚组、呼吸性酸中毒亚组和混合性酸中毒亚组,3组病死率分别为26.0%(38/146)、53.6%(15/28)和61.4%(27/44),并发呼吸性酸中毒患者的病死率为58.3%(42/72),与非呼吸性酸中毒病死率12.1%(44/364)比较,差异有统计学意义〔RR=4.82,95%CI为(3.43,6.80),χ2=81.19,P<0.05〕。结论低氧血症、酸中毒、高乳酸血症可以作为评估脓毒症患者预后的指标,早期进行动脉血气分析对于判断脓毒症患者预后具有重要价值。

Objective To explore the relationship between early arterial blood gas （ABG） analysis and the mortality in sepsis patients. Methods A prospective study was performed on data of 436 spesis patients, admitted to our emergency intensive care unit （EICU） from June 2007 to April 2009, to find out whether hypoxemia, acidosis and lactacidemia existed according to first ABG analysis outcome. The patients were divided into groups based on the outcome, and the 28 d case - fatality rates were compared between all groups. Results A total of 86 patients died within 28 d, with a case - fatality rate of 19.7%. Taking arterial partial pressure of oxygen （ PsO 2） 60 mm Hg as standard, the patients were divided into groups hypoxemia and non-hypoxemia, whose case-fatality rates were 13.4% （41/307）, 34.9% （45/129）, respectively, and the difference was significant （RR = 2.61, 95% CI = 1.81, 3.76, χ^2 = 26. 59, P 〈 O. 05 ）. Taking arterial blood lactate values 2, 4, 9 mmol/L as standards to group, the case -fatality rates of 4 groups were 5.4% （12/224）, 17.0% （18/106）, 41.5% （27/ 65 ）, 70. 7% （29/41）, respectively, increasing with the elevation of lactate values （Pearson contingency coefficient = 0.45, χ^2 = 108.41, P 〈 0.05 ）. According to the existence of acidosis, the patients were divided into groups acidosis and non - acidosis, the case -fatality rates were 36.7% （80/218）, 2. 8% （6/218）, respectively, and the difference was significant （RR = 13.33, 95% CI = 7.54, 23.6, χ^2 = 79. 31, P 〈 0. 05 ）. According to types of acidosis, the patients were divided into sub- groups metabolic acidosis, respiratory and mixed, and the case - fatality rates were 26.0% （ 38/146 ）, 53.6% （ 15/28 ）, 61.4% （27/44）, respectively, and there was significant difference in case -fatality rate between patients with respiratory aci- dosis （58.3%） andwithout （RR=4.82, 95% CI =3.43, 6.80, χ^2=81.19, P〈0. 05）. Conclusion Hypoxemia, acidosis and lactacidemia can be used as predictive indicators for evaluation of prognosis of sepsis patients. Early ABG analysis is of great value in predicting the prognosis in sepsis patients.