中心静脉-动脉血二氧化碳分压差和SOFA评分对感染性休克患者复苏指导的意义-东南大学学报医学版

中心静脉-动脉血二氧化碳分压差和SOFA评分对感染性休克患者复苏指导的意义

单位：扬州大学第五临床医学院常熟市第二人民医院重症医学科, 江苏常熟 215500

分类号：R441.9

出版年·卷·期（页码）：2017·36·第二期（161-165）

摘要：

目的：研究中心静脉-动脉血二氧化碳分压差[P（cv-a）CO₂]和全身性感染相关性器官功能衰竭评分（SOFA）评分对指导感染性休克患者液体复苏及对预后评估的意义。方法：对2014年6月至2015年6月入住我院ICU治疗的34例感染性休克患者进行前瞻性观察性研究。入院后行血常规、C-反应蛋白及血气分析等检查，早期目标指导治疗（EGDT）治疗6 h后查动脉及中心静脉血血气分析，计算此时的P（cv-a）CO₂，根据患者28 d病死率分为死亡组和存活组，比较两组6 h的P（cv-a）CO₂、乳酸、CVP、ScvO₂、EGDT达标率、去甲肾上腺素用量、24 h内的SOFA评分等指标。通过ROC曲线分析P（cv-a）CO₂和SOFA评分对预后的评估价值。结果：复苏6 h死亡组患者的P（cv-a）CO₂明显高于存活组[（7.20±2.20）mmHg vs（4.37±3.71）mmHg，P=0.032]，其对感染性休克患者预后评估的ROC曲线的曲线下面积（AUROC）为0.738，入院24 h内死亡组患者的SOFA评分明显高于存活组，对预后评估的AUROC为0.75。结论：感染性休克患者早期P（cv-a）CO₂及SOFA评分越高预后越差，两者均是预测感染性休克患者严重程度和预后的良好指标。早期监测P（cv-a）CO₂并行SOFA评分可用于指导感染性休克的液体复苏。

Objective: To investigate the guidance and prognostic evaluation value of central venous-arterial carbon dioxide difference[P(cv-a)CO₂] and sepsis-related organ failure assessment(SOFA)score in resuscitation of septic shock patients. Methods: A prospective, observational study was conducted in the ICU of our hospital and 34 patients with septic shock admitted from June, 2014 to June,2015 were included. Routine blood test, C-reactive protein, blood gas analysis were evaluated after admission, in addition, arterial and central venous blood gas analyses at 6 hours after resuscitation were also assessed, and P(cv-a)CO₂ was calculated. According to the mortality rate in 28 days, the patients were divided into death group and survival group. P(cv-a)CO₂, lactate level, CVP, ScvO₂ and the rate to achieve EGDT at 6 hours after resuscitation, the dose of norepinephrine used and SOFA score in 24 hours were compared between the two groups. Prognostic evaluation value of P(cv-a)CO₂ and SOFA score were determined by receiver operating characteristic(ROC) curve. Results: The P(cv-a)CO₂ at 6 hours of resuscitation was significantly higher in death group [(7.20±2.20)mmHg vs(4.37±3.71)mmHg,P=0.032] and the area under ROC curve (AUROC) of P(cv-a)CO₂ for prognostic evaluation was 0.738. The SOFA score during the first 24 hours was significantly higher in death group, and AUROC of SOFA score for prognostic evaluation was 0.75. Conclusion: The higher the patients' P(cv-a)CO₂ and SOFA score are, the worse the prognosis is. Both of P(cv-a)CO₂ and SOFA score can predict the disease severity and prognosis of the patients with septic shock. Early monitoring of P(cv-a)CO₂ and SOFA score can guide the resuscitation of septic shock.

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