Gong S J, Song J, Zhou J D, Yu Y H, Dai H W, Wang M J, Li L, Xu Q H, Yan J
Department of Critial Care Medicine, Zhejiang Hospital, Hangzhou 310013, China.
Zhonghua Nei Ke Za Zhi. 2016 Sep 1;55(9):673-8. doi: 10.3760/cma.j.issn.0578-1426.2016.09.004.
To investigate the prognostic significance of venous-to-arterial carbon dioxide difference to arteriovenous oxygen content difference ratio (Pv-aCO2/Ca-vO2 ratio) combined with lactate in patients with septic shock during the early phases of resuscitation.
A retrospective study was conducted for 104 septic shock patients. All patients received an initial fluid resuscitation according to the Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012(SSC2012). Patients were classified into four groups according to lactate levels and Pv-aCO2/Ca-vO2 ratio at 6 h of resuscitation: group A, lactate≥2.0 mmol/L and Pv-aCO2/Ca-vO2>1.0; group B, lactate≥2.0 mmol/L and Pv-aCO2/Ca-vO2≤1.0; group C, lactate<2.0 mmol/L and Pv-aCO2/Ca-vO2>1.0; group D, lactate<2.0 mmol/L and Pv-aCO2/Ca-vO2≤1.0. The hemodynamic parameters and oxygen metabolism parameters were recorded at baseline and 6 h after fluid resuscitation. Sequential organ failure assessment (SOFA) score at day 1, day 3 were calculated. The 28-day mortality rate was recorded.
(1) Group A had the highest SOFA score at day 3 and group D the lowest, which were respectively 10.8±3.3, 6.7±3.6, 5.6±3.1, 4.1±2.2 in four groups. Accordingly, the 28-day mortality rate of group A was the highest and group D the lowest, which were respectively 83.3%, 59.1%, 60.0%, 14.3% in four groups. The differences were statistically significant (P<0.05). (2) The Cox regression analysis of 28 d mortality revealed that lactate levels (RR=4.306, 95%CI 1.979-9.369) and Pv-aCO2/Ca-vO2 ratio (RR=2.888, 95%CI 1.676-4.976) at T6 were independent predictors to 28-day mortality. (3) The AUCROC of Pv-aCO2/Ca-vO2 ratio combined with lactate [0.910(95%CI 0.857-0.963)] was significantly greater than the AUCROC of wither lactate [0.762(95%CI 0.673-0.852), Z=2.775; P=0.006) or Pv-aCO2/Ca-vO2 ratio [0.781(95%CI 0.693-0.868), Z=2.458; P=0.014) alone.
Combination of Pv-aCO2/Ca-vO2 ratio and lactate level at early stage of resuscitation in patients with septic shock is better than single parameter to predict the prognosis.
探讨脓毒性休克患者复苏早期静脉血与动脉血二氧化碳分压差与动静脉血氧含量差比值（Pv-aCO2/Ca-vO2比值）联合乳酸对预后的评估意义。
对104例脓毒性休克患者进行回顾性研究。所有患者均按照《拯救脓毒症运动：2012年严重脓毒症和脓毒性休克国际治疗指南》（SSC2012）进行初始液体复苏。根据复苏6小时时的乳酸水平和Pv-aCO2/Ca-vO2比值将患者分为四组：A组，乳酸≥2.0 mmol/L且Pv-aCO2/Ca-vO2>1.0；B组，乳酸≥2.0 mmol/L且Pv-aCO2/Ca-vO2≤1.0；C组，乳酸<2.0 mmol/L且Pv-aCO2/Ca-vO2>1.0；D组，乳酸<2.0 mmol/L且Pv-aCO2/Ca-vO2≤1.0。记录基线及液体复苏6小时后的血流动力学参数和氧代谢参数。计算第1天、第3天的序贯器官衰竭评估（SOFA）评分。记录28天死亡率。
（1）第3天A组SOFA评分最高，D组最低，四组分别为10.8±3.3、6.7±3.6、5.6±3.1、4.1±2.2。相应地，A组28天死亡率最高，D组最低，四组分别为83.3%、59.1%、60.0%、14.3%。差异有统计学意义（P<0.05）。（2）28天死亡率的Cox回归分析显示，T6时乳酸水平（RR=4.306，95%CI 1.979-9.369）和Pv-aCO2/Ca-vO2比值（RR=2.888，95%CI 1.676-4.976）是28天死亡率的独立预测因素。（3）Pv-aCO2/Ca-vO2比值联合乳酸的曲线下面积（AUCROC）[0.910（95%CI 0.857-0.963）]显著大于单独乳酸的AUCROC[0.762（95%CI 0.673-0.852），Z=2.775；P=0.006]或单独Pv-aCO2/Ca-vO2比值的AUCROC[0.781（95%CI 0.693-0.868），Z=2.458；P=0.014]。
脓毒性休克患者复苏早期Pv-aCO2/Ca-vO2比值联合乳酸水平预测预后优于单一参数。
