中心静脉-动脉血二氧化碳分压差值评估严重脓毒症患者预后的临床研究

Prognosis of severe sepsis patients assessed by central venous - to - arterial carbon dioxide difference

目的 探讨中心静脉-动脉血二氧化碳分压差值（Pcv-aCO2）在评估严重脓毒症患者预后中的临床价值.方法收集入住我院ICU 96例经过早期液体复苏治疗后中心静脉血氧饱和度（ScvO2）≥70%的严重脓毒症患者的APACHEⅡ评分、ScvO2、6 h Pcv-aCO2、6 h动脉血乳酸清除率和预后的相关资料.按预后不同将患者分为存活组（n=61）和死亡组（n=35）;以Pcv-aCO2 6 mm Hg为界分为高Pcv-aCO2组（≥6 mm Hg,n=40）和低Pcv-aCO2组（〈6 mm Hg,n=56）,比较存活组与死亡组、高Pcv-aCO2组与低Pcv-aCO2组之间相关数值的差异.结果 各组治疗前APACHEⅡ评分、ScvO2、动脉血乳酸比较差异均无统计学意义（P〉0.05 ）.存活组6 h Pcv-aCO2（3.15±1.54） mm Hg,明显低于死亡组[（8.34±1.89）mm Hg,P〈0.01];低Pcv-aCO2组病死率（28.57%）明显低于高Pcv-aCO2组（47.50%,P〈0.05）.存活组和低Pcv-aCO2组6 h血乳酸清除率（26.54±11.21）%和（28.16±12.39）%,明显高于死亡组[（14.96±10.93）%]和高Pcv-aCO2组[（13.82±13.54）%,均P〈0.01].6 h Pcv-aCO2与6 h血乳酸清除率呈负相关（r=-0.719,P〈0.01）.结论早期Pcv-aCO2可作为评估严重脓毒症患者预后的一个指标.

Objective To investigate the clinical value of central venous - to - arterial carbon dioxide difference （ Pcv - aCO2 ） in evaluating the prognosis of patients with severe sepsis. Methods The clinical data of 96 patients with severe sepsis admitted to the Intensive Care Unit （ICU） in our hospital was analyzed, who already had ScvO2 greater than 70% after early resuscitation. APACHE II score, ScvO2, Pcv - aCO2, the lactate clearance after 6 hours were measured and their relationships to prognosis were analyzed. According to the results of following up, the patients were divided into survival group （ S - group, n = 61 ） and non - survival group （ NS - group, n = 35 ）. Based on Pcv - aCO2 （ 6 mm Hg as limit）, the patients were divided into high Pcv- aCO2 group （H- group, I〉 6 mm Hg, n =40） and low Pcv- aCO2 group （L- group, 〈6 mm Hg, n = 56）. Data were compared between the S- group and the NS - group, as well as between the H - group and the L - group. Results There were no statistically significant differences in APACHE I1 score, ScvO2, arterial blood lactate before the treatment between the S - group and the NS - group or between the H - group and the L - group （ P 〉 0. 05）. The 6 h Pcv-aCO2 of the S-group was（3.15 ± 1.54）mm Hg, which was significantly lower than that of the NS - group [ （ 8.34 ± 1.89 ） mm Hg, P 〈 0. 01 ]. The mortality of the L - group （28. 57% ） were lower than that of the H - group （47.50%, P 〈0.05 ）. The 6 h lactate clearance rate of the S - group and L - group was （26.54 ± 11. 21）% and （28.16~ 12. 39）%, which were significantly higher than that of the NS - group （ 14.96 ± 10. 93 ） % and H - group [ （ 13. 82 ± 13.54）%, P 〈 0.01 ]. The level of 6 h Pcv -aCO2 was negatively correlated with the 6 h lactate clearance rate （r= -0.719, P〈0.01）. Conclusion The early level of Pcv - aCO2 serves as a good index for predicting the prognosis of patients with severe sepsis.