氧代谢指标在严重产后出血危重程度和死亡风险早期评价中的价值

Value of Oxygen Metabolism Index in the Early Evaluation of Critical Degree and Death Risk of Severe Postpartum Hemorrhage

目的:探讨氧代谢指标在严重产后出血危重程度和死亡风险早期评价中的价值,为以氧代谢指标为导向的严重产后出血复苏治疗提供依据。方法:选择沈阳市妇婴医院收治的87例严重产后出血患者,分别定义行中心静脉穿刺及桡动脉穿刺即刻为T1时间,行中心静脉穿刺及桡动脉穿刺后6小时为T2时间。以急性生理与慢性健康评分Ⅱ(APACHEⅡ评分)分为高APACHEⅡ评分组(≥20分)和低APACHEⅡ评分组(<20分),比较两组患者T1时间和T2时间的中心静脉血氧饱和度(SCVO2)、乳酸(LAC)、血红蛋白(Hb)、平均动脉压(MAP)及心率(HR)的差异。并进行中心静脉血氧饱和度(SCVO2)和乳酸(LAC)与APACHEⅡ评分的相关性分析。绘制ROC曲线,分析T1时间各项指标在严重产后出血危重程度和死亡风险早期评价中的灵敏度和特异度,计算各指标的曲线下面积(AUC)。结果:高APACHEⅡ评分组T1时间点SCVO2、LAC、HR及Hb与低APACHEⅡ评分组比较差异有统计学意义(P<0.05),高APACHEⅡ评分组T2时间点SCVO2、LAC及Hb与低APACHEⅡ评分组比较差异有统计学意义(P<0.05)。T1时间SCVO2与APACHEⅡ评分呈显著负相关(r=-0.806,P<0.01),LAC与APACHEⅡ评分呈显著正相关关系(r=0.626,P<0.01)。T2时间SCV O2与APACHEⅡ评分呈显著负相关(r=-0.708,P<0.01),LAC与APACHEⅡ评分呈显著正相关(r=0.738,P<0.01)。各项指标在严重产后出血患者中危重程度和死亡风险评价的ROC曲线分析,T1时间SCV O2、LAC、HR、Hb及MAP的AUC分别为0.913(95%CI 0.856~0.970)、0.937(95%CI 0.886~0.988)、0.876(95%CI 0.803~0.947)、0.681(95%CI 0.570~0.792)和0.594(95%CI 0.471~0.716)。T2时间SCVO2、LAC、HR、Hb和MAP的AUC分别为0.951(95%CI 0.934~0.976)、0.984(95%CI 0.972~0.998)、0.484(95%CI 0.354~0.614)、0.801(95%CI 0.710~0.892)和0.479(95%CI 0.353~0.604)。结论:在对严重产后出血危重程度和死亡风险评价中,氧代谢指标SCVO2和LAC在T1与T2时间有相似的效能,且两时间点均优于Hb、HR和MAP,为以氧代谢指标SCVO2和LAC为导向复苏治疗在严重产后出血患者中应用提供依据。

Objective:To explore the value of oxygen metabolism index in the early evaluation of critical degree and death risk of severe postpartum hemorrhage,so as to provide evidence for Oxygen metabolism index guided recovery treatment.Methods:87 cases of severe postpartum hemorrhage were selected in our hospital.T1 was defined as the time when central venipuncture and radial artery puncture were successfully performed.T2was defined as 6 hours after T1.The patients were divided into two groups,high APACHEⅡgroup(APACHEⅡ≥20)and low APACHEⅡ(APACHEⅡ<20).Central venous oxygen saturation(ScvO2),lactic acid(LAC),hemoglobin(HB),man arterial pressure(MAP)and heart rate(HR)were recorded at T1 and T2 in two groups.Central venous oxygen saturation(ScvO2),lactic acid(LAC),hemoglobin(HB),man arterial pressure(MAP)and heart rate(HR)were recorded at T1 and T2 in two groups.Correlation analyses,ROC curve and AUC area calculation were also performed.Results:There exist statistical differences regarding ScvO2,LAC,HR,and HB between two groups at T1 and T2.ScvO2 was inversely associated with APACHEⅡscore at T1 and T2(r=-0.806,P<0.01;r=-0.708,P<0.01)while LAC was positively associated with APACHEⅡscore at T1 and T2(r=0.626,P<0.01;r=0.738,P<0.01)The T1 AUC area of SCVO2,LAC,HR,HB and MAP were 0.913(95%CI 0.856-0.970),0.937(95%CI 0.886-0.988),0.876(95%CI 0.803-0.947),0.681(95%CI 0.570-0.792)and 0.594(95%CI 0.471-0.716)respectively,and the T2 AUC area of SCVO2,LAC,HR,HB and MAP were 0.951(95%CI 0.934-0.976),0.984(95%CI 0.972-0.998),0.484(95%CI 0.354-0.614),0.801(95%CI 0.710-0.892)and 0.479(95%CI 0.353-0.604)respectively.Conclusions:ScvO2 and LAC are effective oxygen metabolism indexes in evaluating the critical degree of severe postpartum hemorrhage and the risk of death and they are superior to other indexes such as HB,HR and MAP,providing evidence for the application of oxygen metabolism indicators guided resuscitation therapy in patients with severe postpartum hemorrhage.