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

doi:103969/jissn1002-1949201712006

Chinese Journal of Critical Care Medicine

2017, Vol. 37

Issue (12): 1096-1100 DOI: 103969/jissn1002-1949201712006

The value of oxygen challenge test in predicting the effect of fluid resuscitation in patients with septic shock

You Yong, Liu Ning, Guo Xiao-fang, Gu Qin

Intensive Care Unit, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing Medical University Medical School, Nanjing 210000, China

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Abstract Objective： To evaluate the clinical value of oxygen challenge test (OCT) in predicting the effect of fluid resuscitation in patients with septic shock. Methods： A prospective observational study was conducted. 54 patients with septic shock admitted to intensive care unit (ICU) of Affiliated Hospital of Nanjing University Medical School from January 2015 to June 2016 were enrolled and given the standard treatment in accordance with the 2014 Chinese severe sepsis/septic shock treatment guidelines. OCT, transcutaneous oxygen pressure (PtcO2), mean arterial pressure (MAP), arterial blood lactic acid (Lac), central venous oxygen saturation (ScvO2) and other hemodynamic monitoring before and 6 h after fluid resuscitation were recorded, and the 6 h lactate clearance rate (LRC) was calculated. The patients were divided into high clearance group (n=32) with 6 h LRC≥10% and low clearance group (n=22) with 6 h LRC＜10%. OCT, PtcO2 and ScvO2 after resuscitation were compared between 2 groups. The receiver-operating characteristics (ROC) analysis was performed to predict the effect of fluid resuscitation of the variables OCT, PtcO2 and ScvO2 after resuscitation. Results：Before resuscitation, the hemodynamic parameters, tissue oxygen metabolism parameters had no significant differences in both groups. Six hours after resuscitation, arterial blood lactic acid is lower in the low clearance group ［(3.3±3.2) mmol/L vs. (7.3±4.1) mmol/L, P=0.010］than the high clearance group, PtcO2 and OCT was higher in the low clearance group ［PtcO2: (88.2±29.2) mm Hg vs. (54.0±25.9) mmol/L,P=0.004; OCT: (90.9±57.5) mm Hg vs. (40.0±19.8) mm Hg,P=0.010］, ScvO2 of 6 h after resuscitation in the 2 groups had no significant difference ［(76.6%±6.5) % vs. (77.7%±7.5)%,P=0.686)］. OCT was significantly negatively correlated with Lac of the same period before and after resuscitation. OCT after 6 h resuscitation and 6 h LRC was significantly and positively correlated, and no correlation between ScvO2 and LRC after resuscitation. The AUC of 6 h OCT (0.836) was greater than 6 h PtcO2 (0.768), while the AUC of 6 h ScvO2 was the smallest (0.416). The best cutoff value of 6 h OCT for the predicting of 6 h LRC≥10% was 61 mm Hg, with the sensitivity 71.9% and the specificity 90.9%. Conclusion： OCT is well correlated with arterial blood lactate and lactate clearance rate in septic shock before and after fluid resuscitation, and can be used to evaluate the effect of fluid resuscitation in patients with septic shock.

Received: 31 July 2017

Corresponding Authors: Gu Qin, E-mail: icuguqin@sina.com

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Cite this article:

ou Yong,Liu Ning,Guo Xiao-fang, et al. The value of oxygen challenge test in predicting the effect of fluid resuscitation in patients with septic shock[J]. Chinese Journal of Critical Care Medicine, 2017, 37(12): 1096-1100.

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http://www.cnemergency.org.cn/EN/103969/jissn1002-1949201712006 OR http://www.cnemergency.org.cn/EN/Y2017/V37/I12/1096

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