摘要目的：评价经皮组织氧负荷试验（oxygen challenge test，OCT）预测感染性休克患者液体复苏效果的临床价值。方法：前瞻性观察性研究，选择2015-01～2016-06收住南京大学医学院附属鼓楼医院重症医学科的54例感染性休克患者，入院后进行规范化治疗。于液体复苏前、复苏后6 h实施OCT，同时进行经皮氧分压（transcutaneous oxygen pressure， PtcO2）、平均动脉压（MAP）、动脉血乳酸（Lac）、中心静脉血氧饱和度（ScvO2）等血流动力学监测。计算6 h乳酸清除率（lactate clearance rate， LRC），根据复苏后6 h LRC分为高清除组（6 h LRC≥10%，n=32）和低清除组（6 h LRC＜10%, n=22），比较2组患者复苏后6 h OCT、PtcO2、ScvO2的变化，绘制受试者工作特征曲线(ROC)，比较其评估液体复苏达标价值。结果：复苏前2组患者血流动力学指标、氧代谢指标比较差异无统计学意义；复苏后6 h高清除组Lac（mmol/L）低于低清除组（3.3±3.2 vs.7.3±4.1，P=0.010），PtcO2（mm Hg）高于低清除组（88.2±29.2 vs.54.0±25.9，P=0.004），氧负荷试验（mm Hg）高于低清除组（90.9±57.5 vs.40.0±19.8，P=0.010），复苏后6 h 2组ScvO2比较差异无统计学意义［（76.6±6.5)% vs.(77.7±7.5)%，P=0.686］。复苏前后OCT均与同时期Lac呈显著负相关，复苏后6 h OCT与LRC呈显著正相关，复苏后ScvO2与LRC无相关性。复苏后6 h OCT的曲线下面积（AUC）为0.836，＞6 h PtcO2的AUC为0.768，6 h ScvO2 的AUC最小为 0.416，6 h OCT预测6 h LRC≥10%的最佳临界值为61 mm Hg，其敏感度71.9%，特异度90.9%。 结论：经皮氧负荷试验与感染性休克患者液体复苏前后Lac和LRC有良好的相关性，可以预测感染性休克患者的液体复苏效果。
尤勇，刘宁，郭晓芳，顾勤. 经皮组织氧负荷试验预测感染性休克患者液体复苏达标的临床价值[J]. 中国急救医学, 2017, 37(12): 1096-1100.
ou Yong, Liu Ning, Guo Xiao-fang, Gu Qin. The value of oxygen challenge test in predicting the effect of fluid resuscitation in patients with septic shock. Chinese Journal of Critical Care Medicine, 2017, 37(12): 1096-1100.
［1］Dellinger RP,Levy MM,Rhodes A,et al.Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012［J］.Intensive Care Med, 2013, 39(2):165-228.
［2］Jones AE,Shapiro NI,Trzeciak S,et al.Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial［J］. JAMA, 2010, 303(8):739-746.
［3］Mihae Yu,Chapital A,Ho HC,et al. A prospective randomized trial comparing oxygen delivery versus transcutaneous pressure of oxygen values as resuscitative goals［J］. Shock, 2007, 27(6):615-622.
［4］何怀武, 刘大为, 隆云,等.脓毒性休克患者经皮氧负荷试验和中心静脉血氧饱和度的相关性［J］.中华医学杂志, 2011, 91（35）:2449-2452.
［5］Mihae Yu,Morita SY,Daniel SR,et al.Transcutaneous pressure of oxygen:a non-invasive and early detector of peripheral shock and outcome［J］.Shock, 2006, 26(5):450-456.
［6］Huai-wu He, Da-wei Liu, Yun Long,et al. The peripheral perfusion index and transcutaneous oxygen challenge test are predictive of mortality in septic patients after resuscitation［J］. Crit Care, 2013, 17(3):R116
［7］ProCESS Investigators, Yealy DM, Kellum JA, et al. A randomized trial of protocol-based care for early septic shock［J］. N Engl J Med, 2014, 370(18):1683-1693.
［8］ARISE Investigators; ANZICS Clinical Trials Group, Peake SL, Delaney A, et al. Coaldirected resuscitation for patients with early septic shockp［J］. N Engl J Med, 2014, 371(16):1496-1506.
［9］Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goaldirected resuscitation for septic shock［J］. N Engl J Med, 2015, 372(14):1301-1311〖ZK)〗
［10］周仙仕,唐光华,李俊.脓毒症早期目标导向治疗策略的局限争议及完善［J］. 中国急救医学, 2016, 36(4):289-293.
［11］Textoris J, Fouché L, Wiramus S. High central venous oxygen saturation in the latter stages of septic shock is associated with increased mortality［J］. Crit Care, 2011, 15(4):R176.
［12］俞辰斌,倪海滨,刘克琴,等.EGDT优化方案在脓毒症治疗中的应用［J］. 中国急救医学, 2016, 36(4):303-306.
［13］Mari A,Vallée F, Bedel J,et al.Oxygen challenge test in septic shock patients:prognostic value and influence of respiratory status［J］. Shock, 2014, 41(6):504-509.
