中心静脉血氧饱和度与剖宫产产后出血的相关性及辅助诊断价值

The correlation between central venous oxygen saturation and postpartum hemorrhage after cesarean section and its diagnostic value

目的研究中心静脉血氧饱和度(ScvO2)与剖宫产产后出血(PPH)的相关性及ScvO2对PPH的辅助诊断价值。方法前瞻性纳入2017年1月1日—2017年12月31日于南华大学附属第一医院产科择期行剖宫产手术患者30例。分别记录患者失血前后血细胞比容(HCT)、血红蛋白(Hb)、ScvO2值及失血量,分析患者失血前后HCT差值(ΔHCT)、Hb差值(ΔHb)、ScvO2差值(ΔScvO2)与PPH失血量的相关性,用受试者工作特征(ROC)曲线分析ΔScvO2对PPH的辅助诊断价值。结果失血前后患者Hb、HCT比较差异无统计学意义(P>0.05)。失血后ScvO2较失血前降低(P<0.05)。ΔHb、ΔHCT与失血量无相关性(P>0.05),ΔScvO2与失血量呈负相关(r=-0.817,P<0.001)。ΔScvO2诊断PPH曲线下面积(AUC)为0.824(95%CI:0.657~0.991,P=0.003)。以ΔScvO2=-6.90为诊断界点时,其对PPH的诊断敏感度为66.7%,特异度为99.4%。结论ΔScvO2与PPH失血量呈负相关,可以作为PPH患者失血量评估及辅助诊断的指标。

Objective To evaluate the correlation between central venous oxygen saturation (ScvO2 ) and postpartum hemorrhage (PPH) after cesarean section and its diagnostic value for PPH. Methods A total of 30 patients underwent elective cesarean section in department of obstetrics of the First Affiliated Hospital of the University of South China from January 1, 2017 to December 31, 2017 were prospectively included. Values of hematocrit (HCT), hemoglobin (Hb), ScvO2 and hemorrhage volume were recorded before and after hemorrhage. Hematocrit differences (ΔHCT), hemoglobin differences (ΔHb), central venous oxygen saturation differences (ΔScvO2 ) were calculated before and after hemorrhage. The correlation between the ΔHCT,ΔHb,ΔScvO2 and hemorrhage volume was studied. The diagnostic value of ΔScvO2 to PPH was analyzed by receiver operating characteristic (ROC) curve. Results There was no significant difference in Hb and HCT in patients before and after hemorrhage (P>0.05). The value of ScvO2 was significantly lower after hemorrhage than that before hemorrhage (P<0.05). There was no correlation between ΔHb,ΔHCT and hemorrhage volume (P>0.05). ScvO2 was negatively correlated with hemorrhage volume (r=-0.817, P<0.001). The area under curve (AUC) of ΔScvO2 was 0.824 (95% CI: 0.657-0.991, P = 0.003). The diagnostic sensitivity and specificity for PPH were 66.7% and 99.4% when ΔScvO2 was -6.90. Conclusion ScvO2 is negatively correlated with PPH hemorrhage volume and can be used as a sensitive index in the diagnosis of PPH.