摘要
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,APACHE Ⅱ,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 APACHE Ⅱ,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].APACHE Ⅱ,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 Pv-aCO2 and LCR are associated with the severity and prognosis of patients with septic shock,and patients with 12 h Pv-aCO2 ＞ 7.25mmHg and 12 h LCR ＜ 12.45％ are more likely to have poor prognosis.关键词
感染性休克/中心静动脉血二氧化碳分压差/乳酸清除率/预后评估Key words
septic shock/central venous-to-arterial carbon dioxide difference/lactate clearance rate/prognosis evaluation分类
医药卫生
