PCT、LAC/ScvO_2对脓毒血症患者病情与预后的评估价值

Assessment value of PCT,LAC/ScvO_2 in prediction of condition judgment and outcome prediction for patients with sepsis

目的:探讨降钙素原(PCT)、乳酸(LAC)与中心静脉血氧饱和度(ScvO_2)的比值(LAC/ScvO_2)对脓毒血症患者病情与预后的评估价值。方法:选取2013年6月至2015年10月我院重症监护室收治的脓毒血症患者122例,根据患者28 d预后分为存活组(n=80)和死亡组(n=42)。比较两组患者血清PCT水平、LAC/ScvO_2、APACHEⅡ评分,分析PCT、LAC/ScvO_2与APACHEⅡ的相关性,并绘制ROC曲线分析PCT、LAC/ScvO_2对脓毒血症患者预后的评估价值。结果:存活组PCT、LAC/ScvO_2、APACHEⅡ评分均明显低于死亡组(P<0.05);Pearson相关性分析显示,PCT、LAC/ScvO_2与APACHEⅡ评分呈明显正相关(P<0.05);PCT、LAC/ScvO_2预测死亡的ROC曲线下面积分别为0.820、0.857,PCT的最佳临界值为2.30 ng·ml-1,其敏感度和特异度分别为75.16%、75.50%,LAC/ScvO_2的最佳临界值为13.25,其敏感度和特异度分别为88.69%、73.12%。结论:PCT、LAC/ScvO_2对脓毒血症患者病情评估和预后预测均具有较高的临床应用价值。

Objective： To discuss the assessment value of procalcitonin（ PCT） and lactic acid（ LAC） to central venous oxygen saturation（ ScvO2） ratio（ LAC /ScvO2） in patients with sepsis. Methods： 122 cases of patients with sepsis from June 2013 to October 2015 in our ICU were selected and they were divided into survival group（ n = 80）and death group（ n = 42） according to the 28 d prognosis. The serum PCT levels,LAC / ScvO2,APACHE Ⅱ score were compared between the two groups,and the correlation of PCT,LAC / ScvO2 with APACHE Ⅱ scores was analyzed,and the assessment value of PCT,LAC / ScvO2 by ROC curve was analyzed in two groups. Results： The PCT,LAC / ScvO2,APACHE Ⅱ scores of survival group were significantly lower than those of death group（ P 〈0. 05）. Pearson correlation analysis showed that PCT,LAC / ScvO2 were significantly correlated with APACHE Ⅱscores（ P 〈 0. 05）. ROC AUC of PCT,LAC / ScvO2 to predict death were 0. 820 and 0. 857,the best critical value of PCT was 2. 30 ng·ml-1,and its sensitivity and specificity were 75. 16%,75. 50%. The best critical value of LAC / ScvO2 was 13. 25,and its sensitivity and specificity were 88. 69%,73. 12%. Conclusion： Both PCT,LAC /ScvO2 have significant values in prediction of condition judgment and outcome prediction for patients with sepsis.