脓毒症患者脑氧饱和度与中心静脉血氧饱和度相关性的临床研究

Clinical study of correlation of central venous oxygen saturation and regional cerebral oxygen saturation in patients with sepsis

目的:通过近红外线光谱技术(NIRS)测定脓毒症患者局部脑氧饱和度(rScO2),探讨中心静脉血氧饱和度(ScvO2)与rScO2的关系。方法:本研究共纳入严重脓毒症和脓毒性休克患者64例,分别在脓毒症确诊后基线时(T1)、24h(T2)、48h(T3)测定ScvO2、rScO2、局部肌氧饱和度(rSmO2)和乳酸含量;调查rScO2和rSmO2在预测ScvO2<70%的价值;对比分析生存患者和死亡患者的ScvO2、rScO2、rSmO2及乳酸含量等临床指标。结果:ScvO2≥70%的患者rScO2水平高于ScvO2<70%的患者[(63.04±8.12)vs.(53.21±14.98),P=0.054];乳酸含量≥2.5mmol/L且ScvO2≥70的患者在观察期内病死率为77.3%;rScO2是ScvO2<70%的显著预测因素(OR=0.871,P=0.004)。结论:乳酸含量和ScvO2水平与严重脓毒症和脓毒性休克的ICU患者的不良预后高度相关。对于严重脓毒症和脓毒性休克的ICU患者可通过持续性监测rScO2以评估ScvO2,有利于患者的预后,值得在临床上推广。

Objective：Use the near infrared spectroscopy（NIRS）to measure regional cerebral oxygen saturation（rScO2）and investigate the correlation between the central venous saturation（ScvO2）and rScO2.Method：A total of 64 patients with severe sepsis or septic shock were included.ScvO2,rSO2,rSmO2 and lactate were measured at the time when sepsis diagnosis was comfirmed baseline（T1）,24hlater（T2）and 48hlater（T3）.We investigated the predictive value of rScO2 and rSmO2for SvcO2〈70%.The ScvO2,rScO2,rSmO2 and lactate were analyzed in survivor and non-survivor groups.Result：Patients with ScvO2≥70% showed a trend of higher level of rScO2 than patients with ScvO2〈70% [（63.04±8.12）vs.（53.21±14.98）,P=0.054].There were 77.3% patients died during the observation period in the group with lactate level≥2.5mmol/L and ScvO2≥70%;rScO2 was the significant predictor of ScvO2〈70%（OR=0.871,P=0.004）.Conclusion：The lactate level and ScvO2 level are highly associated with poor outcome in ICU patients with severe sepsis and septic shock.For ICU patients with severe sepsis and septic shock,the continuous monitoring rScO2 can be used to evaluate ScvO2.It is conducive to the prognosis of patients,and can be reasonable used as a good aption for clinical promotion.