感染性休克患者经皮氧分压与常用氧代谢指标的相关性

Correlation of transcutaneous oxygen pressure and classical oxygen metabolism indexes in patients with septic shock

摘要:

目的 分析感染性休克患者复苏前后经皮氧分压（P_tcO₂）相关指标与常用氧代谢指标的相关性。方法 选取2015年7月—2017年7月浙江医院感染性休克患者40例为研究对象，6 h持续监测P_tcO₂，并于0 h、6 h行氧负荷试验（OCT）、动脉血气分析及中心静脉血气分析。分析P_tcO₂值、OCT值（吸入纯氧10 min后P_tcO₂值-基础P_tcO₂值）与乳酸清除率、中心静脉血氧饱和度（S_cvO₂）之间的相关性。结果 6 h后P_tcO₂及ΔP_tcO₂（6 h P_tcO₂～0 h P_tcO₂）均与乳酸清除率呈正相关（r =0.386和0.555，P <0.05），ΔP_tcO₂与ΔS_cvO₂（6 h S_cvO₂～0 h S_cvO₂）呈正相关（r =0.377，P <0.05），ΔOCT（6 h OCT～0 h OCT）与ΔS_cvO₂呈正相关（r =0.372，P <0.05）。复苏6 h后，P_tcO₂改善程度不同的两组患者，在乳酸清除率、6 h S_cvO₂、去甲肾上腺素需求量上差异有统计学意义（P <0.05），OCT改善程度不同的两组患者，乳酸清除率差异有统计学意义（P <0.05）。结论 复苏前后P_tcO₂、OCT的变化与乳酸清除率、S_cvO₂变化值相关，有可能用于评估复苏的有效性。

Abstract:

Objective To analyze the correlation between transcutaneous oxygen pressure (P_tcO₂) related variables and the classical oxygen metabolism variables before and after resuscitation in patients with septic shock. Methods Forty patients with septic shock were prospectively investigated. P_tcO₂ was continuously monitored for 6 hours, and oxygen challenge test (OCT), arterial blood gas analysis, and central venous blood gas analysis were performed at 0h and 6h. The correlation between P_tcO₂ related variables (P_tcO₂ value and OCT value) and lactate clearance rate and central venous oxygen saturation (S_cvO₂) were analyzed respectively. Results After 6 h, P_tcO₂ value and ΔP_tcO₂ (6 h P_tcO₂ value to 0 h P_tcO₂ value) were positively correlated with lactate clearance rate (r = 0.386 and 0.555, P < 0.05). The positive correlation was also proved between ΔP_tcO₂ and ΔS_cvO₂ (6 h S_cvO₂ to 0 h S_cvO₂) (r =0.377, P < 0.05), ΔOCT (6 h OCT value to 0 h OCT value) and ΔS_cvO₂ (r = 0.372, P < 0.05), respectively. There were significant differences in lactate clearance, 6 h S_cvO₂, and norepinephrine requirement between the two groups with different changes of P_tcO₂ after 6 hours of resuscitation (P < 0.05). There was also a significant difference in lactate clearance between the two groups with different OCT improvements (P < 0.05). Conclusion Changes in P_tcO₂ and OCT before and after resuscitation were related to lactate clearance and changes in S_cvO₂, which may be used to assess the effectiveness of resuscitation.