经皮与血二氧化碳分压梯度监测在脓毒症休克患者的临床意义研究

Clinical significance of percutaneous and blood carbon dioxide partial pressure gradient monitoring in septic shock patients

目的探讨经皮与血二氧化碳分压梯度监测在脓毒症休克患者的临床意义研究。方法选取2017年12月~2019年1月我院收治的脓毒症休克患者66例及非休克患者66例。两组均对动脉血二氧化碳分压(Partial pressure of carbon dioxide in artery,PaCO2)、慢性健康和急性生理状况评分(Acute physiology and chronic health evaluationⅡ,APACHEⅡ)、平均动脉血压(Partial pressure of carbon dioxide,MAP)、中心静脉血氧饱和度(Cardiovenous oxygen saturation,SaCO2)、经皮二氧化碳分压(Comparison of capillary CO2,PcCO2)、静脉血氧饱和度(Systemic central venous oxygen saturation,ScvO2)、酸碱度(pH)、序贯器官功能衰竭评分(Sequential organ failure assessment,SOFA)、动脉血乳酸(Limulus amoebocyte lysate,LAC)、中心静脉压(Capital value process,CVP)、中心静脉-动脉二氧化碳分压差[Central venous-to-arterial carbon dioxide difference,P(c-a)CO2]进行检测。比较两组患者入院时基本情况、目标导向性治疗(Early goal-directed therapy,EGDT)后监测参数的变化、ROC曲线下面积。结果研究组MAP、SaCO2、PaCO2、ScvO2均高于对照组(P<0.05),CVP、PcCO2、LAC、P(c-a)CO2均低于对照组(P<0.05);诊断当天动脉血乳酸面积为0.731,标准误为0.135,渐进Sig.为0.048,渐进95%CI下限为0.467,上限为0.993;诊断当天二氧化碳偏移度面积为0.835,标准误为0.106,渐进Sig.为0.005,渐进95%CI下限为0.631,上限为1.001;诊断24 h动脉血乳酸面积为0.803,标准误为0.115,渐进Sig.为0.008,渐进95%CI下限为0.581,上限为1.001;诊断24 h二氧化碳偏移度面积为0.888,标准误为0.086,渐进Sig.为0.002,渐进95%CI下限为0.718,上限为1.001;APACHEⅡ评分面积为0.803,标准误为0.106,渐进Sig.为0.008,渐进95%CI下限为0.597,上限为1.001。结论在监测脓毒症休克患者的过程中,经皮与血二氧化碳分压梯度监测的效果更加理想,可以更好地预测患者的预后情况,应当进一步推广应用。

Objective To investigate the clinical significance of percutaneous and blood carbon dioxide partial pressure gradient monitoring in septic shock patients.Methods 66 septic shock patients and 66 non-shock patients admitted to our hospital from December 2017 to January 2019 were selected.Both groups were tested for arterial blood CO2 partial pressure(PaCO2),acute physiology and chronic health and grading(APACHEⅡ),partial pressure of carbon dioxide(MAP),cardiovenous oxygen saturation(SaCO2),comparison of capillary CO2(PcCO2),systemic central venous oxygen saturation(ScvO2),pH,sequential organ failure assessment(SOFA),limulus amoebocyte lysate(LAC),capital value process(CVP)and central venous-to-arterial carbon dioxide difference[P(c-a)CO2].The basic conditions of patients at admission,changes in monitoring parameters and area under ROC curve after early goal-directed therapy(EGDT)between the two groups were compared.Results The MAP,SaCO2,and PaCO2,ScvO2 were higher in the study group than in the control group(P<0.05).The CVP,PcCO2,LAC,and P(c-a)CO2 in the study group were significantly lower than that of the control group(P<0.05).On the day of diagnosis,the area of arterial blood lactate was 0.731,the standard error was 0.135,the progressive Sig was 0.048,the lower limit of the progressive 95%CI was 0.467,and the upper limit was 0.993.The area of carbon dioxide offset was 0.835,the standard error was 0.106,the progressive Sig was 0.005,the lower limit of the progressive 95%CI was 0.631,and the upper limit was 1.001.The area of arterial blood lactic acid within 24 h was 0.803,the standard error was 0.115,the progressive Sig was 0.008,the progressive 95%CI was 0.581,and the progressive 95%CI was 1.001.The area of carbon dioxide offset degree within 24 hours of diagnosis was 0.888,the standard error was 0.086,the progressive Sig was 0.002,the lower limit of the progressive 95%CI was 0.718,and the upper limit was 1.001.APACHEⅡscore area was 0.803,standard error was 0.106,progressive Sig.0.008,progressive 95%CI,lower limit was 0.597,up limit was 1.001.Conclusion In the process of monitoring septic shock patients,percutaneous and blood carbon dioxide partial pressure gradient monitoring has more ideal effect,which can better predict the prognosis of patients,and should be further promoted and applied.