摘要
为探讨乳酸清除率联合中心静脉-动脉血二氧化碳分压差(Pcv-aCO_2)监测对于肛肠疾病大出血休克患者复苏情况的评估价值,选取2014年9月至2018年5月我院收治的肛肠疾病大出血休克患者100例作为研究对象。对比患者复苏前及复苏后6h心率、平均动脉压(MVP)、中心静脉压(CVP)、中心静脉血氧饱和度(ScvO_2)、乳酸含量与Pcv-aCO_2水平。复苏24h后根据PICCO监测导管所监测的数据判断患者复苏情况,分为复苏充足组和复苏不足组,对比2组患者复苏6h时的PcvaCO_2、乳酸清除率、ScvO_2;应用ROC曲线分析Pcv-aCO_2、乳酸清除率、ScvO_2对于患者复苏的评估价值。结果显示,与复苏前相比,复苏后6h患者MVP、CVP、ScvO_2显著升高,心率、乳酸含量、Pcv-aCO_2显著降低,差异均有统计学意义,P <0.05。复苏不足者Pcv-aCO_2显著高于复苏充足者,乳酸清除率和ScvO_2均显著低于复苏充足者,差异均有统计学意义,P <0.05。ROC曲线分析各指标对复苏不足的预测价值显示,ScvO_2敏感度为0,特异度为100%;乳酸清除率敏感度为47.1%,特异度为96.4%;Pcv-aCO_2敏感度为100%,特异度为78.3%。结果表明,乳酸清除率、Pcv-aCO_2对于肛肠疾病大出血休克患者复苏预后的评估具有指导意义。
To explore the value of lactic acid clearance(C)combined with monitoring Pcv-aCO2for evaluating emergence of the patients with massive bleeding shock resulting from anorectal disease,100cases of this disease who were admitted and had treated in author's hospital(2014-09-2018-05)were enrolled into this study,and compared their HR,MVP,CVP,ScvO2blood lactic acid,and Pcv-aCO2levels between before emergence and 6hafter emergence,also divided them into group A(emergence enough)and group B (emergence not enough)according to patients' emergence situation judged by PICCO monitored data at 24 h after emergence;then compared and evaluated both groups'value of following data at 6hafter emergence on emergence situation such as Pcv-aCO2,C,ScvO2by using ROC analysis.As results,compared with before emergence at 6hafter emergence MVP,CVP and ScvO2were significantly increased,meanwhile,HR, lactic acid,Pcv-aCO2were significantly decreased,there was statistical difference between them (all,P < 0.05);in group B Pcv-aCO2significantly higher than that in group A;at the same time C,ScvO2so lower, there was statistical difference between them (all,P <0.05);as for prognostic value on emergence not enough of every indexes analysed by using ROC was resepectively showed that ScvO2,sensitivity 0,specificity 100%;C,sensitivity 47.1%,specificity 96.4%,Pcv-aCO2sensitivity 100%,specificity 100%;C,sensitivity 47.1%,specificity 96.4%;Pcv-aCO2sensitivity 100%,specificity 78.3%.Results show that C and PcvaCO2in evaluating emergence prognosis of the patients with massive bleeding shock from anorectal disease surgery have guidance role.
作者
陶维朝
TAO Wei-chao(Dept.of Intensive Medicine,the Second People's Hospital of Baiyin City,Baiyin,Gansu 730900)
出处
《中国肛肠病杂志》
2019年第2期10-12,共3页
Chinese Journal of Coloproctology
基金
白银市科技计划项目(2018-2-28Y)
