外周灌注指数、血乳酸、中心静脉-动脉二氧化碳分压差与动脉-中心静脉氧含量差比值对脓毒症液体复苏预后的评估价值

The evaluation value of perfusion index,lactic acid,ratio of central venous-arterial carbon dioxide pressure difference to arterial-central venous oxygen content difference for the prognosis in fluid resuscitation of sepsis

目的探讨外周灌注指数(PI)、血乳酸(Lac)和中心静脉-动脉二氧化碳分压差与动脉-中心静脉氧含量差比值(Pv-aCO_(2)/Ca-vO_(2))对脓毒症液体复苏预后的评估价值。方法选取2021年7月至2022年12月江门市人民医院收治的82例脓毒症患者为研究对象,给予中心静脉导管进行液体复苏。根据患者28 d预后分为存活组58例和死亡组24例。比较两组患者复苏6 h后的PI、Lac、Pv-aCO_(2)/Ca-vO_(2)。采用受试者工作特征(ROC)曲线分析PI、Lac、Pv-aCO_(2)/Ca-vO_(2)对脓毒症液体复苏预后的评估价值。结果存活组复苏6 h后的PI高于死亡组,Lac、Pv-aCO_(2)/Ca-vO_(2)低于死亡组,差异有统计学意义(P<0.05)。PI、Lac、Pv-aCO_(2)/Ca-vO_(2)预测脓毒症液体复苏不良预后的灵敏度分别为66.67%、75.00%、79.17%,特异度分别为87.93%、86.21%、91.38%,截断值分别为0.350、4.625、1.720。联合预测的灵敏度为87.50%,特异度为94.83%(AUC=0.962)。结论PI、Lac、Pv-aCO_(2)/Ca-vO_(2)评估对脓毒症液体复苏治疗预后具有较好的预测价值。

Objective To investigate the evaluation value of peripheral perfusion index(PI),blood lactic acid(Lac),ratio of central venous-arterial carbon dioxide pressure difference to arterial-central venous oxygen content difference(Pv-aCO_(2)/Ca-vO_(2))for the prognosis in fluid resuscitation of sepsis.Methods A total of 82 patients with sepsis who were admitted to the People's Hospital of Jiangmen from July 2021 to December 2022 were selected as the study subjects.All patients were treated with fluid resuscitation through central venous catheter.According to the 28d prognosis,the patients were divided into a survival group(58 cases)and a death group(24 cases).The two groups were compared in terms of PI、Lac、Pv-aCO_(2)/Ca-vO_(2) at 6h after resuscitation.Receiver operating characteristic(ROC)curve analyses were performed to investigate the evaluation value of PI、Lac、Pv-aCO_(2)/Ca-vO_(2).Results The PI of the survival group after 6 hours of resuscitation was higher than that of the death group,while Lac and Pv-aCO_(2)/Ca-vO_(2) were lower than those of the death group,and the differences were statistically significant(P<0.05).The sensitivity of PI,Lac and Pv-aCO_(2)/Ca-vO_(2) for predicting poor prognosis of fluid resuscitation of sepsis were 66.67%,75.00%and 79.17%.The specificity were 87.93%,86.21%and 91.38%.The cut-off values were 0.350,4.625 and 1.720.The sensitivity and specificity of joint prediction were 87.50%and 94.83%(AUC=0.962).Conclusion The evaluation of PI,Lac and Pv-aCO_(2)/Ca-vO_(2) is helpful for the prognosis of fluid resuscitation of sepsis.