局部氧饱和度及其衍生参数预测脓毒症相关性脑病的价值

Values of regional oxygenation saturation and its derived variables in early predicting sepsis-associated encephalopathy

目的评价早期监测局部氧饱和度(rSO_(2))及其衍生参数预测脓毒症相关性脑病(sepsis-associated encephalopathy,SAE)的价值,探讨其与SAE的关系。方法选择入住麻醉重症监护病房(AICU)的脓毒症患者。入住AICU 24 h内用组织氧合监护仪对患者进行脑氧饱和度(S_(c)O_(2))和鱼际肌氧饱和度(S_(m)O_(2))监测,计算肌-脑组织氧饱和度梯度(S_(m-c)O_(2))。患者每天接受ICU谵妄评估量表(confusion assessment method for the intensive care unit,CAM-ICU)的筛查。根据CAM-ICU结果分为两组:CAM-ICU阳性的为脓毒症合并脑病组(SAE组),阴性的为脓毒症未合并脑病组(NE组)。结果最终纳入脓毒症患者32例,SAE组18例,NE组14例。SAE的发病率为56%,28 d死亡率为56%。SAE组S_(m)O_(2)、S_(m-c)O_(2)较NE组升高(P<0.05)。两组间的S_(c)O_(2)差异无统计学意义(P>0.05)。S_(m)O_(2)、S_(m-c)O_(2)诊断SAE的准确性较高,AUC均>0.7。S_(m)O_(2)诊断SAE时界值为60.3%,敏感度、特异度分别为83.3%、71.5%。S_(m-c)O_(2)诊断SAE时界值为2.23%,敏感度、特异度分别为61.1%、78.6%。结论早期监测局部氧饱和度及其衍生参数可用于预测SAE的发生。

Objective To evaluate the values of regional oxygenation saturation(rSO_(2))and its derived variables in early predicting sepsis-associated encephalopathy(SAE).Methods Patients who were admitted to the anesthesia intensive care unit of our hospital were eligible if they had sepsis.Patients received cerebral oxygen saturation(S_(c)O_(2))test and thenar muscle oxygen saturation(S_(m)O_(2))monitoring with the tissue oxygenation monitor in the first 24 hours of AICU,and the muscle-cerebral oxygen saturation gradient(S_(m-c)O_(2))was calculated.All patients were screened daily with the Confusion Assessment Method for the ICU(CAM-ICU)scores for their consciousness level.Patients were divided into two groups according to CAM-ICU.Those with CAM-ICU positive were assigned to the SAE group,and those with negative to the NE group.Results Thirty-two patients with sepsis were studied,eighteen in the SAE group and fourteen in the NE group.The incidence of SAE was 56%and the 28-day mortality rate was 56%.S_(m)O_(2) and S_(m-c)O_(2) were significantly higher in group SAE than those in group NE(P<0.05).No significant difference in S_(c)O_(2) was found between the 2 groups(P>0.05).S_(m)O_(2) and S_(m-c)O_(2) were more accurate in diagnosing SAE,and the AUC was greater than 0.7.The cut-off value of S_(m)O_(2) in the diagnosis of SAE was 60.3%,and the sensitivity and specificity were 83.3%and 71.5%,respectively.The cut-off value of S_(m-c)O_(2) in the diagnosis of SAE was 2.23%,and the sensitivity and specificity were 61.1%and 78.6%,respectively.Conclusion Regional oxygen saturation and its derived parameters can be used in the early diagnosis of sepsis related encephalopathy.