天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (3): 360-362.doi: 10.11958/59083

• 临床研究 • 上一篇    下一篇

乳酸与中心静脉血氧饱和度的比值对休克患者病情的判断价值

王灵,杨勇灵,王万灵   

  1. 1 黔东南州人民医院 ICU（邮编 556000）， 2神经外科， 3 急诊科
  • 收稿日期:2015-06-15 修回日期:2015-11-06 出版日期:2016-03-15 发布日期:2016-03-15
  • 通讯作者: 王灵 E-mail:463082910@qq.com
  • 作者简介:王灵（1979）， 男， 主治医师， 学士学位， 危重症医学专业， 主要从事急危重症医学相关研究

The superiority to use specific value of lactic and central venous oxygen saturation in shock patients

WANG Ling, YANG Yongling, WANG Wanling   

  1. 1 Department of Intensive Care Unit (ICU), 2 Department of Neurosurgery, 3 Department of Emergency, The People′s Hospital of Qiandongnan, Guizhou 556000, China
  • Received:2015-06-15 Revised:2015-11-06 Published:2016-03-15 Online:2016-03-15
  • Contact: Ling WANG E-mail:463082910@qq.com

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摘要： 目的：探讨乳酸（Lac）与中心静脉血氧饱和度(ScvO2）的比值(Lac/ScvO2)在休克病人的应用价值。方法：随机选取我院2013年1月-2015年4月住急诊ICU的休克病人，在入院时作Lac及ScvO2监测，6小时复查乳酸并计算乳酸清除率（6h-LCR)，24小时内予以急性生理与慢性健康状况评分Ⅱ(acate physicalogy and chronic health evalauation Ⅱ,APACHEⅡ)评分，以入院后28天为研究终点，病人分为生成组与死亡组，比较两组Lac/ScvO2的差异，分析Lac/ScvO2与发生死亡、入院Lac水平、APACHEⅡ评分的相关性，绘制受试者工作特征曲线（ROC曲线）分析Lac/ScvO2、Lac、6h-LCR、ScvO2、APACHEⅡ评分对休克病人预后的预测能力，并比较其优越性。结果：两组在性别、年龄无统计学差异（P＞0.05）。生存组Lac/ScvO2低于死亡组（P<0.05）。两组Lac、ScvO2、6h-LCR、AppachII评分、有明显差异（P<0.05）。Lac/ScvO2与Lac及APACHEⅡ评分呈正相关，（r=0.901，r=0.659，均P<0.01），Lac/ScvO2与是否死亡相关（r=0.512， P<0.01）。Lac/ScvO2的AUC为0.844（0.751，0.937），截断值为5.91，敏感性为86.70%，特异性为67.60%，OR值为16.25。相对于Lac、ScvO2、6h-LCR、APACHEⅡ评分以Lac/ScvO2的AUC、敏感性最高。结论：Lac/ScvO2是休克病人病情危重程度及预后评估较好的指标，对休克病人预后判断Lac/ScvO2优于Lac、ScvO2、6h-LCR及APACHEⅡ评分。

关键词: 乳酸与中心静脉血氧饱和度的比值, 乳酸, 中心静脉血氧饱和度, APACHEⅡ评分, 乳酸清除率, 休克

Abstract: Objective:To investigate the significance of the application value of lactic（Lac） and central venous oxygen saturation(ScvO2 )in shock patients . Methods: Selection the shock patients that stay in the department of emergency intensive care unit(EICU) in our hospital fron January 2013 to April 2015.Monitoring the lactic and ScvO2 at arrive hospital,After 6 hours moniting lactic again to calculate the lactate clearance rate(6h-LCR). Calculate acate physicalogy and chronic health evalauation Ⅱ(APACHE Ⅱ) score within 24 hours .The 28 days after stay hospital is the end ling of study.Patients are divided into generation group and death group. Comparing the difference of Lac/ScvO2 between the two groups , Analyse the correlation of Lac/ScvO2 with death, Lac level , APACHE Ⅱ score. Draw the receiver operating characteristic curve (ROC curve) analysis the ability of Lac/ScvO2 , Lac, 6h-LCR, ScvO2, APACHE Ⅱ score to judge happen derth with shock patients. The end compares the advantages of them. Results: The gender and age of two groups are no statistical difference (P > 0.05).The Lac/ScvO2 of Survival group is lower than the death group (P < 0.05). Lac, ScvO2, 6h-LCR, APACHE Ⅱ score have obvious difference (P < 0.05). Lac/ScvO2 with Lac and APACHE Ⅱ scores were positively correlated, (r = 0.901, r = 0.659, P < 0.01), Lac/ScvO2 related to happen death (r = 0.512, P < 0.01). The AUC of Lac/ScvO2 is 0.844 (0.751, 0.751), The cutoff value is 5.91, Sensitivity is 86.70%, Specificity is 67.60%, OR value is 16.25. Relative to the Lac, ScvO2, 6h-LCR, APACHE Ⅱ score ,The AUC and sensitivity of Lac/ScvO2 is the highest. Conclusions: Lac/ScvO2 is a better indicators for shock patients to evaluation the degree of the severity of illness and prognosis. Lac/ScvO2 is the best than Lac, ScvO2, 6h-LCR and APACHE Ⅱ score to judge prognosis in shock patients.

Key words: shock, lactic acid；diagnosis, differential, ROC curve, APACHE Ⅱ score, central venous oxygen saturation