P(v-a)CO2/C(a-v)O2在早期重症急性胰腺炎患者中的预测价值

Predictive value of P(v-a)CO2/C(a-v)O2 in the early phase of severe acute pancreatitis patients

目的探讨动静脉二氧化碳分压差/氧含量差[P(v-a)CO2/C(a-v)O2]在早期重症急性胰腺炎(severe acute pancreatitis,SAP)患者中的预后评估价值.方法自2017年8月至2018年10月连续性纳入78例SAP患者,根据患者治疗后P(v-a)CO2/C(a-v)O2是否上升分为两组,研究组(上升组,n=32例)和对照组(下降组,n=46例).比较两组一般临床资料,病程中器官功能障碍并发症发生率、临床预后及氧代谢指标,并评估氧代谢指标对患者的预测价值.结果研究组病情危重度、CT评分、胰腺坏死范围及APACHEⅡ评分明显高于对照组(P<0.05);同时病程中研究组休克、急性呼吸窘迫综合征、急性肾损伤、胰腺坏死组织感染(IPN)等并发症发生率明显高于对照组(P<0.05).且与对照组比较,研究组IPN发生更早、ICU及住院天数更长、病死率更高(P<0.05).治疗前两组P(v-a)CO2/C(a-v)O2差异无统计学意义,但研究组治疗后P(v-a)CO2/C(a-v)O2(mm Hg/mL:2.51±1.37 vs.1.91±1.29,P=0.031)以及治疗前后P(v-a)CO2和乳酸明显高于对照组(P<0.05).多因素Logistics回归分析发现,治疗前患者住院死亡危险因素为P(v-a)CO2(P=0.017)及血乳酸(P=0.021),治疗后为P(v-a)CO2(P=0.009)、P(v-a)CO2/C(a-v)O2(P=0.019)及血乳酸(P=0.023).ROC曲线提示,治疗前P(v-a)CO2对SAP死亡预测价值最高,曲线下面积为0.762,最佳诊断界值为7.69 mm Hg;治疗后P(v-a)CO2/C(a-v)O2对SAP死亡预测价值最高,曲线下面积为0.840,最佳诊断界值为2.05 mm Hg/mL.结论P(v-a)CO2/C(a-v)O2在早期SAP患者预后评估中具有良好的临床应用价值,值得临床推广.

Objective To investigate the predictive value of P(v-a)C02/C(a-v)02 in the early phase of severe acute pancreatitis(SAP)patients.Methods A total of 78 SAP patients were continuously enrolled from August 2017 to October 2018.After the treatment,according to whether P(v-a)CO2/C(a-v)02 increased or not,the patients were divided into a study group(n=32 cases,increased)and a control group(n=46 cases,decreased).General clinical data,incidences of organ dysfunction and complications,clinical prognosis,and oxygen metabolism indexes were compared between the two groups,and the predictive value of oxygen metabolism indexes in SAP mortality was evaluated.Results Disease severity,CT score,regions of pancreatic necrosis and APACHE Ⅱ score in the study group were significantly higher than those in the control group(P<0.05).Meanwhile,the incidences of complications such as shock,acute respiratory distress syndrome,acute kidney injury and infected pancreatic necrosis(IPN)in the study group were significantly higher than those in the control group.Additionally,IPN occurred earlier,ICU and hospital stay were longer,and the mortality was higher in the study group(all P<0.05).Before the treatment,no significant difference were found in P(v-a)CO2/C(a-v)O2 between two groups.However,the study group showed significantly higher P(v-a)CO2/C(a-v)O2 after the treatment(mm Hg/mL:2.51±1.37 vs.1.91±1.29,P=0.031),and P(v-a)CO2 and lactic acid in both before and after the treatment than those in the control group(P<0.05).Multivariate Logistic regression analysis showed that the risk factors for SAP in-hospital mortality were P(v-a)CO2(P=0.017)and lactic acid before the treatment(P=0.021)and P(v-a)CO2(P=0.009),P(v-a)CO2/C(a-v)02(P=0.019)and lactic acid(P=0.023)after the treatment.ROC curve indicated that before treatment P(v-a)CO2 had the highest predictive value for SAP mortality,area under the curve was 0.762,and optimal diagnostic boundary value was 7.69 mm Hg.After the treatment,P(v-a)CO2/C(a-v)O2 showed the highest predictive value for SAP mortality,area under the curve was 0.840,and optimal diagnostic boundary value was 2.05 mm Hg/mL.Conclusion P(v-a)CO2/C(a-v)O2 showed good predictive value in the early phase of SAP patients,which was worthy of clinical promotion.