本文選題：中心靜脈-動(dòng)脈血二氧化碳分壓差/動(dòng)脈-中心靜脈血氧含量差比值 + 乳酸　； 參考：《中國呼吸與危重監(jiān)護(hù)雜志》2016年02期

【摘要】：目的觀察膿毒癥患者中心靜脈-動(dòng)脈血二氧化碳分壓差/動(dòng)脈-中心靜脈血氧含量差比值[P(cv-a)CO2/C(a-cv)O2]與動(dòng)脈血乳酸的關(guān)系。方法采用回顧性隊(duì)列研究收集2013年5月至2013年11月南京大學(xué)醫(yī)學(xué)院附屬鼓樓醫(yī)院重癥監(jiān)護(hù)病房收治的36例膿毒癥患者的臨床資料,采用經(jīng)肺熱稀釋法測(cè)定患者心排指數(shù),同時(shí)抽取股動(dòng)脈和中心靜脈血行血?dú)夥治?測(cè)定動(dòng)脈血乳酸值和中心靜脈血氧飽和度(Scv O2),計(jì)算中心靜脈-動(dòng)脈血二氧化碳分壓差[P(cv-a)CO2]、動(dòng)脈-中心靜脈血氧含量差[C(a-cv)O2]、P(cv-a)CO2/C(a-cv)O2、氧輸送(DO2)和氧耗量(VO2)。根據(jù)動(dòng)脈血乳酸水平,將以上數(shù)據(jù)分為正常乳酸組(2 mmol/L)和高乳酸組(≥2 mmol/L),比較兩組間P(cv-a)CO2/C(a-cv)O2及其他氧代謝指標(biāo)的差異。采用受試者工作特征(ROC)曲線比較P(cv-a)CO2/C(a-cv)O2和其他指標(biāo)對(duì)診斷高乳酸血癥的準(zhǔn)確性。結(jié)果共納入36例患者,收集119組數(shù)據(jù)。高乳酸組P(cv-a)CO2/C(a-cv)O2明顯高于正常乳酸組[(1.38±0.76)mm Hg/m L比(2.31±1.01)mm Hg/m L,P0.01],Scv O2、DO2和VO2明顯低于正常乳酸組[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無明顯差異[(5.76±3.70)mm Hg比(6.59±3.70)mm Hg,P0.05]。P(cv-a)CO2/C(a-cv)O2與動(dòng)脈血乳酸呈顯著正相關(guān)(r=0.646,P0.01),Scv O2與動(dòng)脈血乳酸呈顯著負(fù)相關(guān)(r=-0.277,P0.01),而DO2、VO2與乳酸無顯著相關(guān)性(P0.05)。P(cv-a)CO2/C(a-cv)O2的ROC曲線下面積(AUC)為0.820,95%可信區(qū)間(95%CI)0.715~0.925,P0.001;Scv O2的AUC為0.622,95%CI為0.520~0.724,P=0.025。結(jié)論與傳統(tǒng)氧代謝指標(biāo)相比,P(cv-a)CO2/C(a-cv)O2可以準(zhǔn)確反映高乳酸血癥,是判斷膿毒癥患者氧代謝的可靠指標(biāo)。
[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，

本文編號(hào)：1896027