Hospital Pró-Cardíaco, Rio de Janeiro, Brazil, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
J Intensive Care Med. 2010 Mar-Apr;25(2):111-6. doi: 10.1177/0885066609355398. Epub 2009 Dec 9.
Central venous oxygen saturation (ScvO(2)) is a valuable prognostic marker in sepsis. However, its value in cardiac surgery has not been assessed yet. This study aimed at evaluating ScvO(2) as a tool for predicting short-term organ dysfunction (OD) after cardiac surgery.
A prospective cohort including cardiac surgery patients submitted to a goal-oriented therapy to maintain ScvO(2) above 70% was studied. Postoperative blood samples collected at 30 minutes (T1), 6 hours (T2), and 24 hours (T3) for ScvO(2) measurement were selected to further analysis. Two groups were formed according to the absence (G0) or presence (G1) of OD defined as a Sequential Organ Failure Assessment (SOFA) score >or=5 on the third postoperative day. A logistic regression analysis was performed to identify the variables independently associated with OD on the third postoperative day.
From the 246 patients included, 54 (22%) developed OD and were defined as G1. The mortality rates in G0 and G1 were 1.6% and 31.5%, respectively (P < .001). In the comparative analysis between G0 and G1, the ScvO(2) values were remarkably lower in G1 at T1 (66.2 +/- 9.2 vs 62.3 +/- 11.6; P = .009), T2 (69.6 +/- 5.9 vs 63.5 +/- 9.4; P <or= .001), and T3 (69.6 +/- 5.6 vs 64.6 +/- 6.4; P <or= .001). The variables independently associated with OD in the final logistic regression model were Cleveland score (95% CI: 1.13-1.44; OR: 1.27; P < .001), lactate at T3 (95% CI:1.21-3.15; OR 1.95; P = .006), BE at T3 (95% CI:0.69-0.93; OR 0.80; P = .005); ScvO(2) at T2 (95% CI:0.86-0.96; OR 0.91; P = .002), and ScvO(2) at T3 (95% CI:0.83-0.95; OR 0.89; P = .002).
Postoperative ScvO(2) can be a valuable tool to predict OD after major cardiac surgeries. Its kinetics should be carefully followed in that setting.
中心静脉血氧饱和度（ScvO2）是脓毒症有价值的预后标志物。然而，它在心脏手术中的价值尚未得到评估。本研究旨在评估 ScvO2 作为预测心脏手术后短期器官功能障碍（OD）的工具。
前瞻性队列研究纳入接受目标导向治疗以维持 ScvO2 高于 70%的心脏手术患者。选择术后 30 分钟（T1）、6 小时（T2）和 24 小时（T3）采集血样以测量 ScvO2，进行进一步分析。根据术后第 3 天序贯器官衰竭评估（SOFA）评分≥5 定义有无 OD（G0 组和 G1 组），将患者分为两组。使用逻辑回归分析确定与术后第 3 天 OD 相关的独立变量。
在纳入的 246 例患者中，54 例（22%）发生 OD，定义为 G1 组。G0 组和 G1 组的死亡率分别为 1.6%和 31.5%（P<0.001）。在 G0 组和 G1 组的比较分析中，G1 组在 T1（66.2±9.2 与 62.3±11.6；P=0.009）、T2（69.6±5.9 与 63.5±9.4；P<0.001）和 T3（69.6±5.6 与 64.6±6.4；P<0.001）时 ScvO2 值明显较低。最终逻辑回归模型中与 OD 相关的独立变量为克利夫兰评分（95%CI：1.13-1.44；OR：1.27；P<0.001）、T3 时的乳酸（95%CI：1.21-3.15；OR 1.95；P=0.006）、T3 时的 BE（95%CI：0.69-0.93；OR 0.80；P=0.005）；T2 时的 ScvO2（95%CI：0.86-0.96；OR 0.91；P=0.002）和 T3 时的 ScvO2（95%CI：0.83-0.95；OR 0.89；P=0.002）。
术后 ScvO2 可作为预测心脏大手术后 OD 的有价值工具。在这种情况下，应仔细监测其动力学。
