经皮氧分压/二氧化碳分压监测对重症监护患者压力性损伤发生的早期预警价值

The early warning value of transcutaneous oxygen pressure and transcutaneous carbon dioxide pressure in patients with pressure injury in ICU

目的探讨经皮氧分压/二氧化碳分压(TcPO_(2)/TcPCO_(2))监测在重症监护患者压力性损伤发生的早期风险预警价值。方法采用前瞻性临床观察研究,选取2020年12月至2022年6月依次入住中国科学院大学深圳医院(光明)重症医学科的患者为研究对象,记录患者的一般资料,分别监测患者在左侧卧位、仰卧位和右侧卧位时的TcPO_(2)、TcPCO_(2)。根据重症患者的Braden评分将入住患者分为低危组和高危组,分析TcPO_(2)/TcPCO_(2)监测结果。结果本研究共纳入80例患者,低危组(46例)和高危组(34例)的性别、年龄差异均无统计学意义(均P>0.05),两组的Braden评分、压力性损伤发生率差异均有统计学意义(均P<0.05)。低危组和高危组的左侧卧位、仰卧位及右侧卧位的各时间点的TcPO_(2)差异均有统计学意义(均P<0.001)。除了左侧卧位和右侧卧位的第15分钟外,低危组和高危组的仰卧位及右侧卧位其余各时间点的TcPCO_(2)差异均有统计学意义(均P<0.05)。低危组和高危组的左侧卧位、仰卧位及右侧卧位的各时间点的TcPO_(2)/TcPCO_(2)值差异均有统计学意义(均P<0.001)。仰卧位时TcPO_(2)、TcPO_(2)/TcPCO_(2)与Braden评分呈正相关(r=0.680、0.741);TcPCO_(2)与Braden评分呈负相关(r=-0.771)。Braden评分、TcPO_(2)、TcPCO_(2)和TcPO_(2)/TcPCO_(2)值均具有中等的诊断价值,其截断值分别为12.50分、41.48 mmHg、52.29 mmHg、0.91,其曲线下面积分别为0.899、0.727、0.816和0.719,但TcPO_(2)、TcPCO_(2)、TcPO_(2)/TcPCO_(2)值与Braden评分的AUC差异无统计学意义(均P>0.05)。结论TcPO_(2)、TcPCO_(2)和TcPO_(2)/TcPCO_(2)值对重症监护患者的压力性损伤均具有较高的诊断价值。TcPO_(2)/TcPCO_(2)监测对重症监护患者压力性损伤的发生有早期风险预警价值,具有临床推广意义。

Objective To investigate the early warning value of transcutaneous oxygen pressure and transcutaneous carbon dioxide pressure(TcPO_(2)/TcPCO_(2))monitoring in patients with pressure injury in ICU.Methods A prospective clinical observation study was conducted.Patients were selected in the department of critical care medicine of Shenzhen Hospital Affiliated to University of Chinese Academy of Sciences from December 2020 to June 2022.The general information of all patients were recorded.The data of TcPO_(2)and TcPCO_(2)were monitored respectively in left lying position,supine position and right lying position.According to the Braden score of patients,they were divided into low risk group and high risk group,and the monitoring results of TcPO_(2)/TcPCO_(2)were analyzed.Results The study included a total of 80 patients,with 46 patients in the low risk group and 34 patients in the high risk group.There were no significant differences in gender and age between the two groups(both P>0.05).There were significant differences in the Braden score and the incidence of pressure injury between the two groups(both P<0.05).There were statistically significant differences in TcPO_(2)at various time points in the left lying position,supine position and right lying position between the low risk and the high risk groups(all P<0.001).Except for the 15th minute of the left lying position and right lying position,there were statistically significant differences in TcPCO_(2)at all other time points in the supine and right lying positions between two groups(all P<0.05).There were statistically significant differences in TcPO_(2)/TcPCO_(2)values at various time points in different positions between two groups(all P<0.001).In supine position,TcPO_(2)and TcPO_(2)/TcPCO_(2)were positively correlated with the Braden score(r=0.680,0.741).TcPCO_(2)was negatively correlated with the Braden score(r=-0.771).The Braden score,TcPO_(2),TcPCO_(2)and TcPO_(2)/TcPCO_(2)all have moderate diagnostic value.The cut-off values were 12.50,41.48 mmHg,52.29 mmHg and 0.91,respectively.And the AUC were 0.899,0.727,0.816 and 0.719,respectively.However,there were no significant differences in AUC between the TcPO_(2),TcPCO_(2),TcPO_(2)/TcPCO_(2)and Braden score(all P>0.05).Conclusions TcPO_(2),TcPCO_(2)and TcPO_(2)/TcPCO_(2)values all have higher diagnostic value about pressure injury for patients in ICU.TcPO_(2)/TcPCO_(2)monitoring has early risk warning value for the occurrence of pressure injury in ICU,which is worthy of clinical promotion.