Lee Gyeo Ra, Kim Eun Young
Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 137-701, Republic of Korea.
Biomedicines. 2025 Sep 18;13(9):2295. doi: 10.3390/biomedicines13092295.
The venous-to-arterial carbon dioxide partial pressure difference [P(v-a)CO] reflects the adequacy of tissue perfusion, with elevated values suggesting impaired clearance of CO. While its prognostic role has been investigated in septic shock and high-risk surgery, evidence in postoperative critically ill patients remains limited. This study aimed to evaluate the prognostic value of ΔP(v-a)CO after major abdominal surgery and its relationship with microcirculatory markers. : We retrospectively analyzed 86 patients admitted to the intensive care unit (ICU) after major abdominal surgery between September 2020 and October 2023. Arterial and central venous blood gas analyses were performed immediately postoperatively and at 24 h. Patients were stratified into groups according to ΔP(v-a)CO (≤ 0 vs. >0). Postoperative outcomes and correlations with central venous oxygen saturation (ScvO) were assessed. : In the subgroup analysis of patients with an initial P(v-a)CO > 6 mmHg, those in the ΔP(v-a)CO > 0 group required mechanical ventilation (54.5% vs. 22.2%, ) and continuous renal replacement therapy (36.4% vs. 8.9%, ) more frequently, with longer durations of both interventions ( and , respectively). ICU length of stay and the incidence of acute kidney injury were significantly lower in the ΔP(v-a)CO ≤ 0 group. In addition, a modest negative correlation was observed between ScvO measured at 24 h postoperatively and ΔP(v-a)CO. : ΔP(v-a)CO may serve as a useful marker for postoperative risk stratification in critically ill patients undergoing major abdominal surgery. However, given the retrospective design, small sample size, and single-center setting, these findings should be considered hypothesis-generating and require confirmation in larger, prospective multicenter studies.
静脉 - 动脉二氧化碳分压差值[P(v - a)CO₂]反映了组织灌注的充足程度，其值升高提示二氧化碳清除受损。虽然其在感染性休克和高风险手术中的预后作用已得到研究，但在术后重症患者中的证据仍然有限。本研究旨在评估腹部大手术后ΔP(v - a)CO₂的预后价值及其与微循环标志物的关系。：我们回顾性分析了2020年9月至2023年10月期间因腹部大手术入住重症监护病房（ICU）的86例患者。术后即刻及术后24小时进行动脉和中心静脉血气分析。根据ΔP(v - a)CO₂（≤0 vs. >0）将患者分层。评估术后结局以及与中心静脉血氧饱和度（ScvO₂）的相关性。：在初始P(v - a)CO₂>6 mmHg的患者亚组分析中，ΔP(v - a)CO₂>0组的患者更频繁地需要机械通气（54.5% vs. 22.2%）和持续肾脏替代治疗（36.4% vs. 8.9%），且两种干预的持续时间更长（分别为 和 ）。ΔP(v - a)CO₂≤0组的ICU住院时间和急性肾损伤发生率显著更低。此外，术后24小时测得的ScvO₂与ΔP(v - a)CO₂之间存在适度的负相关。：ΔP(v - a)CO₂可能是接受腹部大手术的重症患者术后风险分层的有用标志物。然而，鉴于本研究的回顾性设计、小样本量和单中心设置，这些发现应被视为生成假设，需要在更大规模的前瞻性多中心研究中得到证实。
