摘要
目的 探讨经皮氧分压监测对感染性休克患者预后评估的价值。方法 前瞻性选取南京医科大学附属无锡人民医院重症医学科（ICU）在2013年1月至2015年12月间收治的确诊为感染性休克患者共53例。所有患者均行经皮氧分压监测，分别于液体复苏0h及6h行10min氧负荷试验并计算氧负荷值（10minOCT）及氧负荷指数（OCI），分别记录液体复苏0h及6h的10minOCT、OCI、血流动力学指标、全身氧代谢指标、血管活性药物剂量，并计算APACHEⅡ及SOFA。依据确诊后28d生存情况将患者分为存活组和死亡组,比较两组患者相关临床指标，采用受试者工作特征（ROC）曲线评价10minOCT、OCI对患者预后的判断价值，绘制Kaplan-Meier生存曲线，Log-rank法分析患者生存情况，多因素logistic回归分析筛选影响患者预后的危险因素。结果 存活组和死亡组分别纳入29例及24例患者，存活组6h 10min OCT[（77.55±18.48）mmHg vs. （51.30±21.60）mmHg]及6h OCI[（0.78±0.13） vs. （0.59±0.15）]均高于死亡组（均P〈0.05），存活组APACHEⅡ[（12.48±5.69） vs. （17.25±8.79）]及SOFA[（5.79±1.72） vs. （10.10±2.52）]均低于死亡组（均P〈0.01）。6h 10min OCT及6h OCI预测患者28d死亡的ROC曲线下面积分别为0.86±0.05（95%CI：0.76~0.87,P〈0.01）及0.79±0.08（95%CI：0.64~0.95,P〈0.01），分别以72.00mmHg（灵敏度76.84%，特异度85.03%）及0.76（灵敏度76.84%，特异度77.47%）为最佳界值点。Kaplan-Meier生存曲线表明高6h 10min OCT和高6h OCI患者28d生存率高于低6h 10min OCT（70.86% vs. 31.82%,χ2=7.96,P〈0.01）和低6h OCI患者（75.00% vs. 32.00%,χ2=9.86,P〈0.01）。多因素logistic回归分析显示6h 10min OCT（OR=0.92,95%CI：0.88~0.96,P〈0.01）和6h OCI（OR=0.01,95%CI：0.001~0.023,P〈0.01）均是影响患者预后的相关因素。结论 10minOCT和OCI是早期预测感染性休克患者预后的可靠指标。
Objective To evaluate the prognostic value of transcutaneous oximetry in patients with septic shock. Methods Fifty-three patients with septic shock were enrolled prospectively from January 2013 to December 2015. Transeutaneous oximetry were used to determine the results of 10 min oxygen challenge tests （OCT） carded out at begirming（0 11） and at 6 h after fluid resuscitation respectively. The 10-min OCT value （10 rain OCT） and oxygen challenge index（OCI） were calculated. The APACHE II and SOFA score, hemodynamic variables, oxygen metabolism indexes, dose of vasoactive agents, 10 rain OCT, and OCI at 0 h and at 6 h were recorded. Patients were assigned into survival group and death group according to the 28 d survival. The differences in demographics and clinical data were compared between groups. The role of 10 min OCT and OCI in predicting death was evaluated by receiver operating characteristic curves（ROC）. The Kaplan-Meier surviving curve was created and the survival of the patients was analyzed by the Log-rank test. Risk factors associated with the prognosis were analyzed using the multiple logistic regression analysis. Results There were 29 patients in the survival group and 24 patients in the death group. Compared with death group, 10 min OCT[（77.55±18.48）mmHg vs. （51.30±21.60） mmHg] and OCI [（0.78±0.13） vs. （0.59±0.15）] at 6 h in survival group were significantly higher（P〈0.05）, while APACHE II [（12.48±5.69） vs. （17.25±8.79）] and SOFA [（5.79±1.72） vs. （10.10±2.52）] in survival group were significantly lower than those in death group（P〈0.01）. The area under the ROC curve of 10 min OCT at 6 h and OCI at 6 h for predicting 28 d death were 0.86±0.05（95%CI：0.76-0.87,P〈0.01） and 0.79±0.08（95%CI：0.64-0.95,P〈0.01）, respectively. The optimal cutoff point for 10 rain OCT at 6 h was 72.00 mmHg with the sensitivity of 76.84% and specificity of 85.03%. The optimal cutoff point for OCI at 6 h was 0.76 with the sensitivity of 76.84%
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2018年第3期265-271,共7页
Chinese Journal of Emergency Medicine
基金
国家自然科学基金（81400054）
江苏省自然科学基金（BK20140122）
江苏省青年医学重点人才项目（QNRC2017179）
