P(v-a)CO2/C(a-v)O2在早期重症急性胰腺炎患者中的预测价值

doi:10.3969/j.issn.1002-1949.2019.11.009

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摘要目的探讨动静脉二氧化碳分压差/氧含量差［P(v-a)CO2/C(a-v)O2］在早期重症急性胰腺炎（severe acute pancreatitis， SAP）患者中的预后评估价值。方法自2017年8月至2018年10月连续性纳入78例SAP患者，根据患者治疗后P(v-a)CO2/C(a-v)O2是否上升分为两组，研究组（上升组，n=32例）和对照组（下降组，n=46例）。比较两组一般临床资料，病程中器官功能障碍并发症发生率、临床预后及氧代谢指标，并评估氧代谢指标对患者的预测价值。结果研究组病情危重度、CT评分、胰腺坏死范围及APACHEⅡ评分明显高于对照组（P＜0.05）；同时病程中研究组休克、急性呼吸窘迫综合征、急性肾损伤、胰腺坏死组织感染（IPN）等并发症发生率明显高于对照组（P＜0.05）。且与对照组比较，研究组IPN发生更早、ICU及住院天数更长、病死率更高（P＜0.05）。治疗前两组P(v-a)CO2/C(a-v)O2差异无统计学意义，但研究组治疗后P(v-a)CO2/C(a-v)O2(mm Hg/mL：2.51±1.37 vs.1.91±1.29，P=0.031）以及治疗前后P(v-a)CO2和乳酸明显高于对照组（P＜0.05）。多因素Logistics回归分析发现，治疗前患者住院死亡危险因素为P(v-a)CO2（P=0.017）及血乳酸（P=0.021），治疗后为P(v-a)CO2（P=0.009）、P(v-a)CO2/C(a-v)O2（P=0.019）及血乳酸（P=0.023）。ROC曲线提示，治疗前P(v-a)CO2对SAP死亡预测价值最高，曲线下面积为0.762，最佳诊断界值为7.69 mm Hg；治疗后P(v-a)CO2/C(a-v)O2对SAP死亡预测价值最高，曲线下面积为0.840，最佳诊断界值为2.05mm Hg/mL。结论 P(v-a)CO2/C(a-v)O2在早期SAP患者预后评估中具有良好的临床应用价值，值得临床推广。

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	孟照全
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关键词 ：动静脉二氧化碳分压差/氧含量差［P(v-a)CO2/C(a-v)O2］, 重症急性胰腺炎(SAP）, 预测价值

作者简介: 孟照全(1963-), 男，副主任医师，E-mail:zlds1188@163.com。

引用本文:

孟照全，张朝贵，王桂林. P(v-a)CO2/C(a-v)O2在早期重症急性胰腺炎患者中的预测价值[J]. 中国急救医学, 2019, 39(11): 1053-1057.
Meng Zhao-quan, Zhang Chao-gui, Wang Gui-lin. Predictive value of P(v-a)CO2/C(a-v)O2 in the early phase of severe acute pancreatitis patients. Chinese Journal of Critical Care Medicine, 2019, 39(11): 1053-1057.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2019.11.009 或 http://www.cnemergency.org.cn/CN/Y2019/V39/I11/1053

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