Pcv-aCO_(2)/Ca-cvO_(2)联合ScvO_(2)检测对脓毒症患者预后的预测价值

Predictive value of Pcv-aCO_(2)/Ca-cvO_(2) combined with ScvO_(2) detection on prognosis of patients with sepsis

目的探讨中心静脉-动脉二氧化碳分压差/氧含量差比值(Pcv-aCO_(2)/Ca-cvO_(2))联合中心静脉血氧饱和度(ScvO_(2))检测对脓毒症患者预后的预测价值。方法选择2016年6月至2019年6月该院收治的脓毒症患者进行回顾性分析,根据离开医院时的结局分为存活组及死亡组,比较两组患者一般资料、实验室指标、Pcv-aCO_(2)/Ca-cvO_(2)及ScvO_(2)的差异,采用COX回归模型分析预后的影响因素,采用Kaplan-Meier曲线分析不同Pcv-aCO_(2)/Ca-cvO_(2)及ScvO_(2)患者预后的差异,采用受试者工作特征(ROC)曲线分析Pcv-aCO_(2)/Ca-cvO_(2)及ScvO_(2)对预后的预测价值;采用Logistic回归模型分析两项指标联合检测对脓毒症预后的预测价值。结果与存活组比较,死亡组患者的Pcv-aCO_(2)/Ca-cvO_(2)、肌酐、尿素氮、降钙素原、急性生理和慢性健康状态评分Ⅱ(APACHEⅡ评分)明显增加(P<0.05),ScvO_(2)、清蛋白水平明显降低(P<0.05);经COX回归模型分析,Pcv-aCO_(2)/Ca-cvO_(2)、ScvO_(2)、APACHEⅡ评分是脓毒症患者预后的影响因素;经Kaplan-Meier曲线分析,不同Pcv-aCO_(2)/Ca-cvO_(2)及ScvO_(2)患者的预后差异有统计学意义(P<0.05);经ROC曲线分析,Pcv-aCO_(2)/Ca-cvO_(2)及ScvO_(2)对脓毒症患者的预后具有预测价值;在Logistic回归模型中生成Pcv-aCO_(2)/Ca-cvO_(2)联合ScvO_(2)预测脓毒症患者预后的新指标,该指标对脓毒症患者预后的预测价值优于单一指标。结论Pcv-aCO_(2)/Ca-cvO_(2)及ScvO_(2)是脓毒症患者预后的影响因素,Pcv-aCO_(2)/Ca-cvO_(2)联合ScvO_(2)用于预测脓毒症患者预后具有更优的灵敏度和特异度。

Objective To investigate the predictive value of Pcv-aCO_(2)/Ca-cvO_(2) combined with ScvO_(2) detection on the prognosis of the patients with sepsis.Methods The patients with sepsis admitted to this hospital from June 2016 to June 2019 were selected for conducting the retrospective study.The patients were divided into the survival group and death group according to the outcome when leaving the hospital,The differences of general data,laboratory indicators,Pcv-aCO_(2)/Ca-cvO_(2) and ScvO_(2) between the two groups were compared.The COX regression model was used to analyze the influencing factors of prognosis,and Kaplan-Meier curve was used to analyze the difference of prognosis among the patient with different Pcv-aCO_(2)/Ca-cvO_(2) and ScvO_(2).The ROC curve was used to analyze the predictive value of Pcv-aCO_(2)/Ca-cvO_(2) and ScvO_(2) on prognosis.The Logistic regression model was adopted to analyze the predictive value of the two indicators combined detection in the prognosis of sepsis.Results Compared with the survival group,Pcv-aCO_(2)/Ca-cvO_(2),Cr,BUN,PCT and APACHEⅡscore in the death group were significantly increased(P<0.05),the ScvO_(2) and ALB levels were significantly decreased(P<0.05);by the COX regression analysis,Pcv-aCO_(2)/Ca-cvO_(2),ScvO_(2) and APACHEⅡscore were the influencing factors of prognosis;by the Kaplan-Meier curve analysis,the prognosis of the patients with different Pcv-aCO_(2)/Ca-cvO_(2) and ScvO_(2) were statistically different(P<0.05);by ROC curve analysis,Pcv-aCO_(2)/Ca-cvO_(2),ScvO_(2) and APACHEⅡscore were the influencing factors of the prognosis in the patients with sepsis.After Kaplan-Meier curve analysis,the difference in prognosis had statistical significance among the patients with different Pcv-aCO_(2)/Ca-cvO_(2) and ScvO_(2)(P<0.05).The ROC curve analysis showed that Pcv-aCO_(2)/Ca-cvO_(2) and ScvO_(2) had the predictive value for the prognosis in the patients with sepsis;in the Logistic regression model,the new indicators of Pcv-aCO_(2)/Ca-cvO_(2) combined with ScvO_(2) for predicting the prognosis in the patients with sepsis were generated,which had the predictive value for the prognosis in the patients with sepsis,moreover which were superior to the single index.Conclusion Pcv-aCO_(2)/Ca-cvO_(2) and ScvO_(2) are the influencing factors of the prognosis in the patients with sepsis,Pcv-aCO_(2)/Ca-cvO_(2) combined with ScvO_(2) has better sensitivity and specificity in predicting the prognosis of the patients with sepsis.