中心静脉血与动脉血二氧化碳分压差、中心静脉血氧饱和度、乳酸清除率对感染性休克预后不良的预测

doi:10.3969/j.issn.1006⁃5725.2021.02.016

实用医学杂志 ›› 2021, Vol. 37 ›› Issue (2): 210-214.doi: 10.3969/j.issn.1006⁃5725.2021.02.016

中心静脉血与动脉血二氧化碳分压差、中心静脉血氧饱和度、乳酸清除率对感染性休克预后不良的预测

冯开俊，宋秋鸣，武道荣，薛明

安徽医科大学合肥第三临床学院（合肥市第三人民医院）重症医学科（合肥 230041）

出版日期:2021-01-25 发布日期:2021-01-25
通讯作者: 宋秋鸣 E⁃mail：281290490@qq.com
基金资助:
安徽省医学会急诊临床研究（编号：ky2018025）

Prognosis prediction of patients with septic shock by using the combination of Pcv ⁃aCO2，ScvO2 and LCR

FENG Kaijun，SONG Qiuming，WU Daorong，XUE Ming

The Third People′s Hospital of Hefei Department of Criti⁃cal Care Medicine，Hefei 230041，China

Online:2021-01-25 Published:2021-01-25
Contact: SONG Qiuming E⁃mail：281290490@qq.com
Supported by:

摘要/Abstract

摘要：

目的探讨中心静脉血与动脉血二氧化碳分压差（Pcv⁃aCO2）、中心静脉血氧饱和度（ScvO2）、乳酸清除率（LCR）联合对感染性休克患者预后不良的预测价值。方法回顾性分析 2015 年 3 月至 2020 年 5 月收治的 70 例感染性休克患者的临床资料，均在入院后 6、24 h 检测 Pcv⁃aCO2、ScvO2，且均计算入院 6、 24 h 的 LCR。所有患者均实施常规治疗，统计预后情况；对比预后良好和预后不良患者 Pcv⁃aCO2、ScvO2、 LCR 及其变化率；采用受试者工作特征曲线（ROC）分析三者联合对感染性休克患者预后不良的预测效能。结果预后不良发生率为 27.14%；预后不良患者入院后 6、24 h Pcv⁃aCO2均高于预后良好患者，入院后 6、24 h ScvO2及 LcR 均低于预后良好患者，预后良好患者入院后 24 h Pcv⁃aCO2低于入院后 6 h，入院后 24 h ScvO2高于入院后 6 h，入院后 24 h LCR 高于入院后 6 h；预后不良患者 Pcv⁃aCO2、ScvO2、LCR 变化率均低于预后良好患者。上述差异均有统计学意义（P＜0.05）；Pcv⁃aCO2、ScvO2、LCR 变化率预测感染性休克预后不良的 Cut⁃off 值分别为 10.32%、4.69%、32.25%，三者联合预测感染性休克预后不良的灵敏度与单独预测相似，三者联合预测的特异度、AUC 均高于单独预测。结论感染性休克患者预后不良发生风险高，采用Pcv⁃aCO2、ScvO2、LCR

关键词:

中心静脉血, 动脉血, 二氧化碳分压, 血氧饱和度, 乳酸清除率, 感染性休克

Abstract:

Objective The aim of this study was to explore the predictive value of the combination of central venous blood and arterial carbon dioxide partial pressure difference（Pcv ⁃aCO2），central venous oxygen saturation（ScvO2）and lactate clearance rate（LCR）on prognosis of patients with septic shock. Methods The clinical data of 70 patients with septic shock from March 2015 to may 2020 were retrospectively collected and ana⁃ lyzed. Pcv⁃aCO2 and ScvO2 were detected at 6 h and 24 h after admission，and LCR at 6 h and 24 h after admission were calculated. All patients received routine treatment and the prognosis were analyzed. Pcv ⁃ aCO2，ScvO2 and LCR were compared between patients with good and poor prognosis. The change rates of Pcv⁃aCO2，ScvO2 and LCR in patients were compared. Receiver operating characteristic curve（ROC）was applied to analyze the predictive efficacy of the combination of the three methods for poor prognosis in patients with septic shock. Results The inci⁃ dence of poor prognosis was 27.14%. Pcv ⁃aCO2 of patients with poor prognosis were higher than those with good prognosis at 6 h and 24 h after admission，and ScvO2 at 6 h and 24 h after admission were lower than those with good prognosis. Meanwhile，LCR at 6 h and 24 h after admission were lower than those in patients with good prog⁃ nosis. The Pcv⁃aCO2 of patients with good prognosis 48 hours after admission was lower than that at 6 h after admis⁃ sion，and ScvO2 was higher than that at 24 h after admission，and the LCR at 24 h after admission was higher than that at 6 h after admission in patients with good prognosis. The change rates of Pcv⁃aCO2，ScvO2 and LCR in patients with poor prognosis were lower than good prognosis. The differences were statistically significant（P < 0.05）. The cut off values of Pcv⁃aCO2，ScvO2 and LCR were 10.32%，4.69% and 32.25% respectively. The sensitivity of combined prediction of poor prognosis of septic shock was similar to that of single prediction. The specificity and AUC of combined prediction were higher than those of single prediction. Conclusion The risk of poor prognosis in patients with septic shock is high. The combination of the change rates of Pcv⁃aCO2，ScvO2 efficiency in predicting poor prognosis.

Key words:

central venous blood, arterial blood, partial pressure of carbon dioxide, oxygen satura?tion, lactate clearance rate, septic shock

冯开俊宋秋鸣武道荣薛明.

中心静脉血与动脉血二氧化碳分压差、中心静脉血氧饱和度、乳酸清除率对感染性休克预后不良的预测

[J]. 实用医学杂志, 2021, 37(2): 210-214.

FENG Kaijun, SONG Qiuming, WU Daorong, XUE Ming.

Prognosis prediction of patients with septic shock by using the combination of Pcv ⁃aCO2，ScvO2 and LCR

[J]. The Journal of Practical Medicine, 2021, 37(2): 210-214.

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中心静脉血与动脉血二氧化碳分压差、中心静脉血氧饱和度、乳酸清除率对感染性休克预后不良的预测

Prognosis prediction of patients with septic shock by using the combination of Pcv ⁃aCO2，ScvO2 and LCR

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