Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou, China.
J Clin Monit Comput. 2021 May;35(3):435-442. doi: 10.1007/s10877-020-00594-9. Epub 2020 Sep 23.
The transcutaneous oxygen challenge test (OCT) is associated with central venous oxygen saturation and cardiac output index, and has predictive value for prognosis. Whether the change of transcutaneous oxygen pressure (PO)-related variables can reflect lactate clearance in sepsis patients is worth studying. We conducted a prospective observational study of 79 patients with sepsis or septic shock in the ICU. Immediately after enrollment, PO monitoring was continuously performed for 6 h. The OCT was performed at enrollment (T0) and the sixth hour (T6). The correlation between lactate clearance and PO-related variables such as PO at T6, ΔPO (PO at T6 - PO at T0), ΔPO index (PO/PaO at T6 - PO/PaO at T0), 10 OCT [(PO after 10 min on FiO of 1.0) - (PO at baseline)], Δ10 OCT (10 OCT at T6 - 10 OCT at T0) was analyzed. The difference of PO-related variables was compared between the high and low lactate clearance groups. PO at T6 (r = 0.477, p < 0.001), ΔPO (r = 0.592, p < 0.001), ΔPO index (r = 0.553, p < 0.001) and Δ10 OCT (r = 0.379, p = 0.001) were significantly correlated with the lactate clearance. To discriminate low lactate clearance, the area under the ROC curve was largest for ΔPO, which was 0.804. PO at T6, PO index, ΔPO, ΔPO index and Δ10 OCT were significantly different between the two different lactate clearance groups. Low lactate clearance in the initial 6 h of resuscitation of septic shock was associated to lower improvements in PO-related variables.
经皮氧挑战试验（OCT）与中心静脉血氧饱和度和心输出指数相关，具有预后预测价值。经皮氧分压（PO）相关变量的变化是否能反映脓毒症患者乳酸清除情况值得研究。我们对 ICU 中 79 例脓毒症或脓毒性休克患者进行了前瞻性观察研究。入组后立即连续进行 6 小时 PO 监测。在入组时（T0）和第 6 小时（T6）进行 OCT。分析了乳酸清除率与 PO 相关变量（T6 时 PO、ΔPO（T6 时 PO-T0 时 PO）、ΔPO 指数（T6 时 PO/PaO-T0 时 PO/PaO）、10 OCT[FiO1.0 时 10 分钟后 PO-（基线时 PO）]、Δ10 OCT（T6 时 10 OCT-T0 时 10 OCT））之间的相关性。比较了高乳酸清除组和低乳酸清除组之间 PO 相关变量的差异。T6 时 PO（r=0.477，p<0.001）、ΔPO（r=0.592，p<0.001）、ΔPO 指数（r=0.553，p<0.001）和 Δ10 OCT（r=0.379，p=0.001）与乳酸清除率显著相关。为了区分低乳酸清除率，ΔPO 的 ROC 曲线下面积最大，为 0.804。在两个不同乳酸清除率组之间，T6 时 PO、PO 指数、ΔPO、ΔPO 指数和 Δ10 OCT 有显著差异。脓毒性休克复苏最初 6 小时内低乳酸清除与 PO 相关变量改善程度较低有关。
