脓毒症合并急性呼吸窘迫综合征患者中心静脉血-动脉血二氧化碳分压差与预后的相关性

Correlation between central venous-to-arterial carbon dioxide partial pressure difference and prognosis of sepsis patients with acute respiratory distress syndrome

目的探讨脓毒症合并急性呼吸窘迫综合征(ARDS)患者中心静脉血-动脉血二氧化碳分压差(Pcv-aCO2)与预后的相关性。方法回顾性分析2015年8月至2018年8月濮阳市人民医院重症医学科收治的90例脓毒症合并ARDS患者的临床资料,并将其作为研究组,另选择同期健康体检者70例为对照组。根据研究组患者结局,将其分为生存组(n=71)和死亡组(n=19)。比较各组患者急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、中心静脉血氧饱和度(ScvO2)、C反应蛋白(CRP)、血清降钙素原(PCT)、Pcv-aCO2差异,并研究Pcv-aCO2与APACHEⅡ、SOFA、CRP、ScvO2、PCT评分的相关性及Pcv-aCO2对合并ARDS脓毒症患者的预后价值。结果研究组患者Pcv-aCO2、CRP、SOFA、APACHEⅡ、PCT均高于对照组,且ScvO2低于对照组(P<0.05);死亡组患者APACHEⅡ、Pcv-aCO2、PCT、CRP、SOFA高于生存组,且ScvO2低于生存组(P<0.05)。Pcv-aCO2与SOFA、APACHEⅡ评分、CRP、PCT均呈正相关,与ScvO2呈负相关(P<0.05)。Pcv-aCO2预测脓毒症合并ARDS死亡受试者工作特征曲线下面积为0.832,4.72 mmHg(1 mmHg=0.133 kPa)时为最佳截断值,敏感度为94.70%,特异度为59.20%。结论Pcv-aCO2对合并ARDS的脓毒症患者预后有较高预测价值。

Objective To investigate the correlation between central venous-to-arterial carbon dioxide partial pressure difference(Pcv-aCO2)and prognosis in sepsis patients with acute respiratory distress syndrome(ARDS).Methods The clinical data of 90 ARDS patients admitted in Puyang People’s Hospital from August 2015 to August 2018 were analyzed retrospectively,and the patients were selected as study group.Meanwhile,another 70 persons had physical exam at the same period were set as control group.Study group was further divided into two subgroups according to the patients’outcomes,survival group(n=71)and death group(n=19).Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,Sequential Organ Failure Assessment(SOFA)score,central venous oxygen saturation(ScvO2),C-reactive protein(CRP),procalcitonin(PCT)and Pcv-aCO2 were compared between the study group and control group,between survival group and death group.The correlation of Pcv-aCO2 with APACHEⅡ,SOFA,CRP,ScvO2,PCT were analyzed,and the predictive value of Pcv-aCO2 for prognoses of sepsis patients with ARDS was also determined.Results Pcv-aCO2,CRP,SOFA,PCT and APACHEⅡin study group were higher than those in control group,and ScvO2 was lower than that in control group(P<0.05);APACHEⅡ,Pcv-aCO2,PCT,CRP and SOFA in death group were higher than those in survival group,and ScvO2 was lower than that in survival group(P<0.05).Pcv-aCO2 was significantly positively correlated with SOFA,APACHEⅡscore,CRP and PCT,and it was significantly negatively correlated with ScvO2(P<0.05).The area under receiver operating characteristic curve of Pcv-aCO2 in predicting the death of sepsis patients with ARDS was 0.832,with best cutoff value of 4.72 mmHg(1 mmHg=0.133 kPa);the sensitivity and specificity of the Pcv-aCO2 in assessing prognosis were 94.70%and 59.20%,respectively.Conclusions Pcv-aCO2 has a high predictive value for the prognosis of sepsis patients with ARDS.