静脉-动脉二氧化碳分压差与动脉-静脉氧含量差比值对儿童腹膜炎相关脓毒性休克的预测价值

Predictive value of the ratio of venous-to-arterial carbon dioxide partial pressure difference to arteriovenous oxygen content difference for peritonitis - associated septic shock in children

目的 探讨静脉-动脉二氧化碳分压差与动脉-静脉氧含量差比值对儿童腹膜炎相关脓毒性休克的预测。方法 回顾性分析2016年12月至2021年12月在西安交通大学附属儿童医院重症医学科收治的63例腹膜炎相关脓毒性休克的临床资料。数据分析采用SPSS21.0统计学软件,根据不同预后将患儿分为存活组及死亡组,正态分布的连续性变量组间比较采用独立样本t检验,分类变量采用χ^(2)检验,应用二元Logistic回归对各变量进行预后预测评价,对具有预测价值的变量采用受试者工作特征曲线(ROC)进行预测分析,以曲线下面积(AUC)>0.5为具有预测价值。结果 共纳入63例患儿,男性30例,女性33例。两组间性别、年龄、体重及病原菌分布差异无统计学意义;死亡组在呼吸机辅助通气、外科干预比率、血管活性药物应用比例,前降钙素原、血清乳酸、静脉-动脉二氧化碳分压差与动脉-静脉氧含量差比值、儿童序贯性器官功能障碍评分、活化部分凝血活酶时间、儿科危重症死亡危险评分指标较存活组升高,在血小板计数、纤维蛋白原、平均动脉压等指标较存活组降低,差异均具有统计学意义(P<0.05);通过二元Logistic回归分析筛选变量发现血清乳酸及静脉-动脉二氧化碳分压差与动脉-静脉氧含量差比值为可能影响预后的独立危险因素。通过ROC曲线发现乳酸AUC为0.745、敏感度75%、特异度71%;静脉-动脉二氧化碳分压差与动脉-静脉氧含量差比值AUC为0.876、敏感度85%、特异度87%;两者联合AUC 0.923;敏感度88%、特异度91%。结论 静脉-动脉二氧化碳分压差与动脉-静脉氧含量差比值对儿童腹膜炎相关脓毒性休克预后具有良好的预测价值。

Objective To investigate the prediction of the ratio of venous-to-arterial carbon dioxide partial pressure difference to arteriovenous oxygen content difference in peritonitis-associated septic shock in children. Methods The clinical data of 63 cases of peritonitis-associated septic shock treated in the Paediatric Intensive Care Unit of the Children’s Hospital Affiliated to Xi’an Jiaotong University from December 2016 to December 2021 were collected and analyzed retrospectively. The data were analyzed by SPSS21.0 statistical software. According to different prognosis, the children were divided into survival group and death group. An independent sample t-test was performed to compare the differences in continuous quantitative variables with normal distribution between the two groups. Categorical variables were compared using a Pearson’s Chi-square test. Binary Logistic regression was used to evaluate all variables for prognosis prediction, and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of risk factors. The area under the curve(AUC)being >0.5 was considered as being with predictive value. Results A total of 63 children were enrolled, including 30 males and 33 females. There were no significant differences in gender, age, weight or pathogen distribution between the two groups. Compared with the survival group, the death group was higher in proportion of ventilation, surgical intervention and vasoactive agents use, procalcitonin, lactate, the ratio of venous-to-arterial carbon dioxide partial pressure difference to arteriovenous oxygen content difference, pediatric sequential organ dysfunction score, activated partial thromboplastin time, and score of the pediatric risk of mortality, but was lower in platelets, fibrinogen and mean arterial pressure All the differences were statistically significant(all P<0.05). Binary Logistic regression analysis was used to screen the variables and it was found that serum lactate and the ratio of venous-to-arterial carbon dioxide partial pressure difference to arteriovenous oxygen content difference were independent risk factors that might affect prognosis. ROC curve showed that lactate AUC was 0.745 with a sensitivity of 75% and specificity of 71%;AUC of the ratio of venous-to-arterial carbon dioxide partial pressure difference to arteriovenous oxygen content difference was 0.876,with sensitivity being 85% and specificity 87%.The combined AUC was 0.923,sensitivity being 88% and specificity being 91%. Conclusion The ratio of venous-arterial carbon dioxide partial pressure difference to arterial-venous oxygen content difference has a good predictive value for the prognosis of peritonitis-associated septic shock in children.