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谭德敏, 谭孟源, 陈军, 蒙振发, 王御林. 中心静动脉血CO2分压差及乳酸清除率对感染性休克患者的预后评估价值[J]. 解放军医学院学报, 2017, 38(12): 1118-1122. DOI: 10.3969/j.issn.2095-5227.2017.12.007
引用本文: 谭德敏, 谭孟源, 陈军, 蒙振发, 王御林. 中心静动脉血CO2分压差及乳酸清除率对感染性休克患者的预后评估价值[J]. 解放军医学院学报, 2017, 38(12): 1118-1122. DOI: 10.3969/j.issn.2095-5227.2017.12.007
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TAN Demin, TAN Mengyuan, CHEN Jun, MENG Zhenfa, WANG Yulin. Prognostic value of Pv-aCO2 and LCR in patients with septic shock[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2017, 38(12): 1118-1122. DOI: 10.3969/j.issn.2095-5227.2017.12.007
Citation: TAN Demin, TAN Mengyuan, CHEN Jun, MENG Zhenfa, WANG Yulin. Prognostic value of Pv-aCO2 and LCR in patients with septic shock[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2017, 38(12): 1118-1122. DOI: 10.3969/j.issn.2095-5227.2017.12.007
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中心静动脉血CO2分压差及乳酸清除率对感染性休克患者的预后评估价值

Prognostic value of Pv-aCO2 and LCR in patients with septic shock

    摘要
  • 摘要: 目的 探讨中心静动脉血二氧化碳分压差(central venous-to-arterial carbon dioxide difference，Pv-aCO2)及乳酸清除率(lactate clearance rate，LCR)对感染性休克患者预后的评估价值。 方法 选取2014年1月- 2017年3月本院收治的感染性休克患者156例，根据6 h Pv-aCO2和6 h LCR分为低Pv-aCO2组(Pv-aCO2< 6 mmHg)(1 mmHg=0.133 kPa)和高Pv-aCO2组(Pv-aCO2≥6 mmHg)，低LCR组(LCR≤10%)和高LCR组(LCR> 10%)，比较各组Pv-aCO2、LCR、急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluation scoring system，APACHEⅡ)评分、序贯器官衰竭评分(sequential organ failure assessment，SOFA)及病死率。应用受试者工作特征(receiver operating characteristic，ROC)曲线分析各时间点Pv-aCO2及LCR对感染性休克患者的预后评估价值。Pearson相关分析Pv-aCO2与LCR的相关性。 结果 高PvaCO2组APACHEⅡ、SOFA评分及病死率均明显高于低Pv-aCO2组(24.16±7.50 vs 19.38±6.72，8.96±3.18 vs 6.92±2.70，62.2% vs 17.6%，P均< 0.05)，而高Pv-aCO2组6 h LCR及6 h早期目标导向治疗(early goal-directed therapy，EGDT)达标率明显低于低Pv-aCO2组(17.28%±6.92% vs 26.53%±10.26%，52.4% vs 85.1%，P均< 0.05)。低LCR组APACHEⅡ、SOFA评分、6 h Pv-aCO2及病死率均明显高于高LCR组23.72±7.41 vs 19.75±6.63，9.05±3.16 vs 6.83±2.74，(7.48±3.70) mmHg vs (4.92±2.25) mmHg(1 mmHg=0.133 kPa)，66.1% vs 24.5%，P均< 0.05，而低LCR组6 h EGDT达标率明显低于高LCR组(48.4% vs 80.9%，P< 0.05)。ROC曲线显示，12 h Pv-aCO2及12 h LCR评估感染性休克患者预后的最佳截断值分别为7.25 mmHg和12.45%，敏感度和特异度均较好，分别为80.6%和90.4%，85.2%和92.7%。相关分析显示，感染性休克患者6 h、12 h及24 h Pv-aCO2与6 h、12 h及24 h LCR均呈负相关(r=-0.648，P< 0.01；r=-0.706，P< 0.01；r=-0.591，P< 0.01)。 结论 Pv-aCO2及LCR变化与感染性休克患者的病情严重程度及预后相关，12 h Pv-aCO2高于7.25 mmHg及12 h LCR低于12.45%的患者预后较差。

     

    Abstract: Objective To investigate the prognostic value of central venous-to-arterial carbon dioxide difference (Pv-aCO2) and lactate clearance rate (LCR) in patients with septic shock. Methods One hundred and fifty-six patients with septic shock admitted to our hospital from January 2014 to March 2017 were enrolled in our study. According to the 6 h Pv-aCO2 and the 6 h LCR level, patients were divided into the low Pv-aCO2 group (Pv-aCO2< 6 mmHg) versus high Pv-aCO2 group (Pv-aCO2 ≥ 6 mmHg), and low LCR group (LCR≤10%) versus high LCR group (LCR> 10%). Pv-aCO2, LCR, APACHEⅡ, SOFA score and mortality in patients of two groups were compared. The receiver operating characteristic (ROC) curve was used to analyze the prognostic value of Pv-aCO2 and LCR at different time points in patients with septic shock. Pearson correlation analysis was used to analyze the correlation between Pv-aCO2 and LCR. Results The APACHEⅡ, SOFA score and mortality in the high Pv-aCO2 group were significantly higher than those in the low Pv-aCO2 group(24.16±7.50) vs (19.38±6.72), (8.96±3.18) vs (6.92±2.70), 62.2% vs 17.6%, all P< 0.05, while the 6-hour LCR and success rate of achieving 6-hour early goal-directed therapy (EGDT) in high Pv-aCO2 group were significantly lower than those in the low Pv-aCO2 group (17.28%±6.92%) vs (26.53%±10.26%), 52.4% vs 85.1%, all P< 0.05. APACHEⅡ, SOFA score, 6-hour Pv-aCO2 and mortality of low LCR group were significantly higher than those in high LCR group (23.72±7.41) vs (19.75±6.63), (9.05±3.16) vs (6.83±2.74), (7.48±3.70) mmHg vs (4.92±2.25) mmHg, 66.1% vs 24.5%, all P< 0.05, while the success rate of achieving 6-hour EGDT of low LCR group was significantly lower than those in high LCR group (48.4% vs 80.9%, P< 0.05). The ROC curve showed that the optimal cut-off values of 12-hour Pv-aCO2 and LCR for evaluating prognosis of septic shock patients were 7.25 mmHg and 12.45%, and the sensitivity and specificity were 80.6% and 90.4%for Pv-aCO2, 85.2% and 92.7% for LCR. Correlation analysis showed that Pv-aCO2 was negatively correlated with LCR at 6, 12 and 24 hour in patients with septic shock (r=-0.648, P< 0.01; r=-0.706, P< 0.01; r=-0.591, P< 0.01). Conclusion Changes in PvaCO2 and LCR are associated with the severity and prognosis of patients with septic shock, and patients with 12 h Pv-aCO2> 7.25 mmHg and 12 h LCR< 12.45% are more likely to have poor prognosis.

     

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