经皮氧负荷试验在感染性休克患者合并急性呼吸窘迫综合征中的应用价值研究

Value of transcutaneous oxygen challenge test in predicting onset of acute respiratory distress syndrome during fluid resuscitation in septic shock patients

目的探讨经皮氧负荷试验在感染性休克患者合并急性呼吸窘迫综合征(ARDS)中的应用。方法选择2014年1月至2016年1月应诊断为感染性休克就诊南京医科大学附属苏州医院ICU,分别在液体复苏第0、6小时实施经皮氧分压监测的成年患者40例。其中,液体复苏后第6小时行10 min氧负荷试验并计算氧负荷值(OCT),将10 min OCT≥66 mmHg的20例患者作为A组,10 min OCT<66 mmHg的20例患者作为B组。比较两组患者第0、6小时10 min OCT、平均动脉压(MAP)、中心静脉压(CVP)、中心静脉氧饱和度(ScvO2)、动脉血乳酸(Lac)、感染性休克相关ARDS的发病率、分级、有创机械通气比例、ICU病死率及28 d病死率的差异。结果两组患者第0小时MAP、CVP、ScvO2、Lac、10 min OCT水平的差异无统计学意义(P>0.05);两组患者第0、6小时的MAP、CVP、ScvO2、Lac水平的差值进行比较,差异无统计学意义(P>0.05),10 min OCT水平的差值进行比较,差异有统计学意义(P<0.05)。B组患者感染性休克相关ARDS、重度ARDS发生率及有创机械通气比例分别为85.00%、50.00%和45.00%,均高于A组,差异有统计学意义(P<0.05);B组患者28 d病死率为90%,高于A组,差异有统计学意义(P<0.05)。第6小时10 min OCT≥66 mmHg是影响患者预后保护性因素(P<0.05)。结论经皮氧负荷试验是评估感染性休克患者液体复苏过程中发生ARDS的可靠指标。

Objective To evaluate the predictive value of percutaneous oxygen load test for acute respiratory distress syndrome(ARDS) in patients with septic shock during fluid resuscitation.Methods From January 2014 to January 2016, 40 adult patients diagnosed as septic shock and admitted to the ICU of Suzhou Hospital Affiliated to Nanjing Medical University were selected. Percutaneous oxygen partial pressure monitoring was performed at the 0 th and 6 th hours of fluid resuscitation among them, and 10 min oxygen load test was performed 6 h after liquid resuscitation and oxygen load value(OCT) was calculated. The 10 min OCT≥ 66 mmHg was treated as group A, and the 20 patients with 10 min OCT<66 mmHg as group B. Average arterial pressure(MAP), central venous pressure(CVP), central venous oxygen saturation(ScvO2), arterial blood lactate(Lac), septic shock-related ARDS(ARDS) incidence, grade, ratio of invasive mechanical ventilation, ICU mortality and mortality on day 28 were compared between the two groups. Results MAP, CVP, ScvO2, Lac, 10 min OCT at 0 h were compared between the two groups, and the difference was not statistically significant(P>0.05). The difference in MAP,CVP,ScvO2,Lac level at 0 h and 6 h in two groups was not statistically significant(P>0.05). The difference in OCT level at 10 min was statistically significant(P<0.05).The incidence of septic shock-related ARDS, the proportion of severe ARDS and the proportion of invasive mechanical ventilation in group B were 85.00%, 50.00% and 45.00%, respectively, which were all higher than those in group A(35.00%, 15.00% and 15.00%), and the difference was statistically significant(P<0.05).The case fatality rate of patients in group B on 28 d was 90%, higher than that of group A(35%), and the difference was statistically significant(P<0.05).OCT at 10 min 6 h after oral glucose ≥ 66 mmHg was a protective factor for death in ICU(P<0.05) and death at 28 d(P<0.05). Conclusion Transcutaneous oxygen challenge test is a reliable indicator to predict ARDS during fluid resuscitation in septic shock patients.