中心静脉-动脉血二氧化碳分压差预测脓毒性休克的预后

Prediction of the prognosis in patients with septic shock by the 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(central venous-arterial carbondioxide difference,Pcv-a CO_2)在预测脓毒性休克预后中的价值。方法 30例脓毒性休克患者,依据预后将其分为存活组(n=14)和死亡组(n=16)。测定及比较两组入重症监护病房(intensive care unit,ICU)即刻血乳酸浓度、Pcv-a CO_2及入ICU6 h动脉血乳酸浓度、Pcv-a CO_2、乳酸清除率。以6 h Pcv-a CO_2是否低于6 mm Hg(1 mm Hg=0.133 k Pa)将患者分为高Pcv-a CO_2组和低Pcv-a CO_2组,比较两组28 d病死率和6 h乳酸清除率,并对6 h乳酸清除率和6 h Pcv-a CO_2进行相关性分析。应用SPSS 22.0统计软件进行数据分析。结果与死亡组比较,存活组入ICU即刻血乳酸浓度(4.60±1.30)mmol/L、6 h血乳酸浓度(3.10±1.20)mmol/L、入ICU即刻Pcv-a CO_2(5.12±1.26)mm Hg、6 h Pcv-a CO_2(3.28±1.62)mm Hg明显降低;存活组6 h乳酸清除率(24.50±3.30)mmol/L明显增高,差异具有统计学意义(P<0.05)。低Pcv-a CO_2组与高Pcv-a CO_2组6 h乳酸清除率、28 d病死率比较,差异有统计学意义(P<0.05)。6 h Pcv-a CO_2与6 h乳酸清除率呈显著负相关。结论脓毒性休克患者高Pcv-a CO_2预后不良,6 h Pcv-a CO_2可能具有良好的评估预后的作用。

Objective The study is aimed to analyze the value of central venous-to-arterial carbon dioxide difference （Pcv-aCO2） in predicting the prognosis of patients with septic shock. Methods Thirty patients with septic shock were divided into survival group and dead group in accordance with prognosis. Blood concentration of lactate and Pcv-aCO2 after immediate admission to intensive care unit （ICU）, blood concentration of lactate, Pcv-aCO2 and lactate clearance rate 6 h after admission to ICU were tested and compared between two groups. The patients were divided into high Pcv-aCO2 group and low Pcv-aCO2 group according to whether the 6-hour Pcv-aCO2 was below 6 mmHg or not, 28-day mortality rate and 6-hour lactate clearance rate were compared between the two groups. The correlation between 6-hour Pcv-aCO2 and 6-hour lactate clearance rate was assessed. Using SPSS 22.0 software for statistical analysis. Results The blood concentration of lactate level after immediate admission to ICU （4.60 ±1.30）, 6-hour blood concentration of lactate level （3.10 ± 1.20）, Pcv- aCO2 after immediate admission to ICU （5.12 ±1.26） and 6-hour Pev-aCO2 （3.28 ±1.62） reduced obviously in survival group as compared with dead group （P〈0.05）, 6-hour lactate clearance rate （24.50 ±3.30） increased obviously in survival group as compared with dead group （P〈0.05）. 6-hour lactate clearance rate and the patients＇ 28-day mortality rate in high Pcv-aCO2 group （11.26± 8.87） and low Pcv-aCO2 group （22.32 ± 9.32） showed significant difference （P〈0.05）. 6-hour Pcv-aCO2 was negatively correlated with the 6-hour lactate clearance rate. Conclusions Septic shock patients with high 6-hour Pcv-aCO2 have an unfavorable prognosis, the 6-hour Pcv-aCO2 can be used as a good marker to predict prognosis of septic shock patients.