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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,P<0.01],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P<0.05],P(cv-a)CO2无明显差异[(5.76±3.70)mm Hg比(6.59±3.70)mm Hg,P>0.05]。P(cv-a)CO2/C(a-cv)O2与动脉血乳酸呈显著正相关(r=0.646,P<0.01),Scv O2与动脉血乳酸呈显著负相关(r=-0.277,P<0.01),而DO2、VO2与乳酸无显著相关性(P>0.05)。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,P<0.001;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。
Objective To observe the relationship between central venous-arterial carbon dioxide partial pressure difference and arterial-central venous oxygen content difference [P (cv-a) CO2 / C (a-cv) O2] and arterial blood lactate in patients with sepsis. Methods A retrospective cohort study was conducted to collect the clinical data of 36 septic patients admitted to the intensive care unit of Drum Tower Hospital, Nanjing University Medical College from May 2013 to November 2013. The cardiomyocyte index Arterial blood lactic acid and central venous oxygen saturation (Scv O2) were measured at the same time, blood gas analysis of the femoral artery and central venous blood was performed to calculate the difference of central venous-arterial carbon dioxide partial pressure [P (cv-a) CO2] Central venous blood oxygen content difference [C (a-cv) O2], P (cv-a) CO2 / C (a-cv) O2, oxygen delivery (DO2) and oxygen consumption (VO2). The above data were divided into normal lactate group (<2 mmol / L) and high lactate group (> 2 mmol / L group) according to arterial blood lactate level. ) O2 and other oxygen metabolism index differences. The receiver operating characteristic (ROC) curve was used to compare the accuracy of P (cv-a) CO2 / C (a-cv) O2 and other parameters in the diagnosis of hyperlipidemia. Results A total of 36 patients were enrolled and 119 sets of data were collected. The P (cv-a) CO2 / C (a-cv) O2 in high lactate group was significantly higher than that in normal lactate group [(1.38 ± 0.76) mm Hg / m L ], Scv O2, DO2 and VO2 were significantly lower than those of the normal lactate group [Scv O2: (74.26 ± 9.13)% vs (70.29 ± 9.72)%; DO2: (505.52 ± 208.39) m L / (min · m2) ± 173.63) m L / (min · m2), VO2: (129.01 ± 54.94) m L / (min · m2) vs (109.99 ± 38.79) m L / cv-a) CO2 had no significant difference [(5.76 ± 3.70) mm Hg vs (6.59 ± 3.70) mm Hg, P> 0.05]. There was a significant positive correlation between P (cv-a) CO2 / C (a-cv) O2 and arterial blood lactic acid (r = 0.646, P <0.01) <0.01), while there was no significant correlation between DO2, VO2 and lactate (P> 0.05). The area under the ROC curve (AUC) for P (cv-a) CO2 / C (a-cv) O2 was 0.820 and 95% confidence interval (95% CI) 0.715-0.925, P <0.001; AUC for Scv O2 was 0.622 , 95% CI 0.520 ~ 0.724, P = 0.025. Conclusions P (cv-a) CO2 / C (a-cv) O2 can accurately reflect the condition of hyperlipidemia, which is a reliable indicator of oxygen metabolism in sepsis patients.