Pcv-aCO_(2)/Ca-cvO_(2)联合LCR与脓毒症休克患者预后的相关性研究

Relationship between the prognosis of septic shock patients and the combination of Pcv-aCO/Ca-cvO and LCR

目的探讨中心静脉-动脉二氧化碳分压差(Pcv-aCO_(2))/动脉-中心静脉氧含量差(Ca-cvO_(2))联合乳酸清除率(lactate clearance rate, LCR)对脓毒症休克患者预后的评估作用。方法选取2017年1月~2019年3月在我院治疗的脓毒症休克患者110例,均给予常规复苏治疗,比较28 d病死者与存活者复苏6 h Pcv-aCO_(2)/Ca-cvO_(2)、LCR、急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分和序贯器官衰竭(SOFA)评分等。结果 110例患者中,28 d病死者39例,28 d病死率为35.45%;病死组复苏6 h Pcv-aCO_(2)/Ca-cvO_(2)、APACHEⅡ评分和SOFA评分分别为(2.15±0.41)、(20.15±3.22)和(10.10±2.09)分,明显高于存活组(P<0.05),而LCR为(21.03±9.44)%,明显低于存活组(P<0.05);Pcv-aCO_(2)/Ca-cvO_(2)与APACHEⅡ评分和SOFA评分呈正相关(r=0.304,0.311,P<0.05),LCR与APACHEⅡ评分和SOFA评分呈负相关(r=-0.324,-0.336,P<0.05);Pcv-aCO_(2)/Ca-cvO_(2)、LCR及联合诊断患者28 d病死的ROC曲线下面积分别为0.680、0.815和0.873(P<0.05)。结论 Pcv-aCO_(2)/Ca-cvO_(2)及LCR在判断脓毒症休克患者预后方面有一定应用价值,值得进一步研究。

Objective To investigate the role of differential pressure of carbon dioxide between central vein and artery(Pcv-aCO_(2))/arterial central venous oxygen content difference(Ca-cvO_(2)) combined with lactate clearance rate(LCR) in evaluating the prognosis of patients with septic shock. Methods One hundred and ten patients with septic shock who were treated in our hospital from January 2017 to March 2019 were selected, all patients were given routine resuscitation, the Pcv-aCO_(2)/Ca-cvO_(2), LCR, acute physiology and chronic health score Ⅱ(APACHE Ⅱ) and sequential organ failure(SOFA) scores at resuscitation for 6 h were compared between the dead and the survivors of 28 d. Results Among 110 patients, 39 died in 28 d, and the fatality rate in 28 d was 35.45%;The Pcv-aCO_(2)/Ca-cvO_(2), APACHEⅡ and SOFA scores of the dead group were(2.15±0.41),(20.15±3.22) and(10.10±2.09), which were significantly higher than those of the living group(P<0.05), while the LCR was(21.03±9.44)%, which was significantly lower than those of the living group(P<0.05);Pcv-aCO_(2)/Ca-cvO_(2) were positively correlated with APACHEⅡ score and SOFA score(r=0.304, 0.311, P<0.05), while LCR were negatively correlated with APACHEⅡ score and SOFA score(r=-0.324,-0.336, P<0.05);The area under ROC curve of Pcv-aCO_(2)/Ca-cvO_(2), LCR and combined diagnosis of 28 d mortality were 0.680, 0.815 and 0.873(P<0.05). Conclusion Pcv-aCO_(2)/Ca-cvO_(2) and LCR have certain application value in judging the prognosis of septic shock patients, which is worth further study.