脓毒症患者中心静脉-动脉血二氧化碳分压差与动脉-中心静脉血氧含量差的比值和乳酸的相关性研究

发布时间：2018-05-16 07:40

  本文选题：中心静脉-动脉血二氧化碳分压差/动脉-中心静脉血氧含量差比值 + 乳酸　； 参考：《中国呼吸与危重监护杂志》2016年02期

【摘要】：目的观察脓毒症患者中心静脉-动脉血二氧化碳分压差/动脉-中心静脉血氧含量差比值[P(cv-a)CO2/C(a-cv)O2]与动脉血乳酸的关系。方法采用回顾性队列研究收集2013年5月至2013年11月南京大学医学院附属鼓楼医院重症监护病房收治的36例脓毒症患者的临床资料,采用经肺热稀释法测定患者心排指数,同时抽取股动脉和中心静脉血行血气分析,测定动脉血乳酸值和中心静脉血氧饱和度(Scv O2),计算中心静脉-动脉血二氧化碳分压差[P(cv-a)CO2]、动脉-中心静脉血氧含量差[C(a-cv)O2]、P(cv-a)CO2/C(a-cv)O2、氧输送(DO2)和氧耗量(VO2)。根据动脉血乳酸水平,将以上数据分为正常乳酸组(2 mmol/L)和高乳酸组(≥2 mmol/L),比较两组间P(cv-a)CO2/C(a-cv)O2及其他氧代谢指标的差异。采用受试者工作特征(ROC)曲线比较P(cv-a)CO2/C(a-cv)O2和其他指标对诊断高乳酸血症的准确性。结果共纳入36例患者,收集119组数据。高乳酸组P(cv-a)CO2/C(a-cv)O2明显高于正常乳酸组[(1.38±0.76)mm Hg/m L比(2.31±1.01)mm Hg/m L,P0.01],Scv O2、DO2和VO2明显低于正常乳酸组[Scv O2:(74.26±9.13)%比(70.29±9.72)%;DO2:(505.52±208.39)m L/(min·m2)比(429.98±173.63)m L/(min·m2);VO2:(129.01±54.94)m L/(min·m2)比(109.99±38.79)m L/(min·m2),均P0.05],P(cv-a)CO2无明显差异[(5.76±3.70)mm Hg比(6.59±3.70)mm Hg,P0.05]。P(cv-a)CO2/C(a-cv)O2与动脉血乳酸呈显著正相关(r=0.646,P0.01),Scv O2与动脉血乳酸呈显著负相关(r=-0.277,P0.01),而DO2、VO2与乳酸无显著相关性(P0.05)。P(cv-a)CO2/C(a-cv)O2的ROC曲线下面积(AUC)为0.820,95%可信区间(95%CI)0.715~0.925,P0.001;Scv O2的AUC为0.622,95%CI为0.520~0.724,P=0.025。结论与传统氧代谢指标相比,P(cv-a)CO2/C(a-cv)O2可以准确反映高乳酸血症,是判断脓毒症患者氧代谢的可靠指标。
[Abstract]:Objective to investigate the relationship between arterial lactate and central veno-arterial carbon dioxide partial pressure difference / arterial central venous oxygen content difference ratio (P(cv-a)CO2/C(a-cv)O2) in patients with sepsis. Methods from May 2013 to November 2013, 36 patients with sepsis in the intensive care unit of Gulou Hospital affiliated to Medical College of Nanjing University were collected by retrospective cohort study. The cardiac output index was measured by transpulmonary heat dilution method. At the same time, the femoral artery and central venous blood were taken for blood gas analysis. The arterial lactoic acid value and central venous oxygen saturation were measured. The central veno-arterial partial pressure difference (P(cv-a)CO2) was calculated. The arterial central venous oxygen content difference (C(a-cv)O2) was measured. According to the level of arterial lactate, the above data were divided into normal lactic acid group (2 mmol / L) and high lactate group (鈮，

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