CAJ | 학술논문

目的探讨中心静脉血氧饱和度(ScvO_2)在重症肺炎患者中的应用价值.方法随机选择2006年1月-2009年4月我院符合重症肺炎诊断的患者90例,每天1次监测患者ScvO_2,根据监测结果将所有病例分为两组:A组为前2次ScvO_2检测值均< 65%(共38例),B组为对照组(即前2次ScvO_2检测值至少有1次≥65%,共52例).比较两组患者的28 d病死率、多脏器功能障碍综合征(MODS)发生率、严重脓毒症(SEPSIS)发生率、急性心力衰竭发生率、急性肾衰竭发生率,以及两组患者在病程中ScvO_2及血乳酸水平的变化情况.结果两组患者的28 d病死率、MODS发生率、严重SEPSIS发生率、急性心力衰竭发生率、急性肾衰竭发生率比较差异均有统计学意义(P<0.05).随病情进展,A组患者ScvO_2水平呈逐渐下降趋势,且A组检测值与B组比较差异均有统计学意义(P<0.05).A组患者血乳酸水平第15天起出现明显升高,第15～28天检测值与B组比较差异均有统计学意义(P<0.01).结论 ScvO_2可以反映重症肺炎患者的病情严重度,可能可以作为患者预后的早期预测指标之一,且ScvO_2的降低程度与患者的病情危重性存在明显相关性,若出现ScvO_2持续降低,则患者的病死率将大大增加.在病情发展中,ScvO_2比乳酸等监测指标更早出现异常,是一个较为灵敏的监测指标.
목적 탐토중심정맥혈양포화도(ScvO_2)재중증폐염환자중적응용개치.방법 수궤선택2006년1월-2009년4월아원부합중증폐염진단적환자90례,매천1차감측환자ScvO_2,근거감측결과장소유병례분위량조:A조위전2차ScvO_2검측치균< 65%(공38례),B조위대조조(즉전2차ScvO_2검측치지소유1차≥65%,공52례).비교량조환자적28 d병사솔、다장기공능장애종합정(MODS)발생솔、엄중농독증(SEPSIS)발생솔、급성심력쇠갈발생솔、급성신쇠갈발생솔,이급량조환자재병정중ScvO_2급혈유산수평적변화정황.결과 량조환자적28 d병사솔、MODS발생솔、엄중SEPSIS발생솔、급성심력쇠갈발생솔、급성신쇠갈발생솔비교차이균유통계학의의(P<0.05).수병정진전,A조환자ScvO_2수평정축점하강추세,차A조검측치여B조비교차이균유통계학의의(P<0.05).A조환자혈유산수평제15천기출현명현승고,제15～28천검측치여B조비교차이균유통계학의의(P<0.01).결론 ScvO_2가이반영중증폐염환자적병정엄중도,가능가이작위환자예후적조기예측지표지일,차ScvO_2적강저정도여환자적병정위중성존재명현상관성,약출현ScvO_2지속강저,칙환자적병사솔장대대증가.재병정발전중,ScvO_2비유산등감측지표경조출현이상,시일개교위령민적감측지표.
Objective To study the clinical value of central venous oxygen saturation (ScvO_2) in patients with severe pneumonia. Methods Totally 90 patients with severe pneumonia were randomly selected from January 2006 to April 2009, the ScvO_2 was monitored once a day, All the patients were divided into two groups according to the results of the monitoring: group A (n=38) in which the values of ScvO_2 for the first two times <65%, and group B (controls, n=52) in which the value of ScvO_2≥65% at least for one time in the first two. The conditions of the two groups were compared, including incidences of death, multiple organ dysfunction syndromes (MODS), severe sepsis, acute cardiac failure and acute renal failure during the 28 days, as well as the changes of ScvO_2 and serum lactic acid during the courses. Results There were significant differences between the two groups in the incidences of death, MODS, severe sepsis, acute cardiac failure and acute renal failure during the 28 days (P<0.05). With the progress of disease, the ScvO_2 value of group A was in a tendency of decrease and was significantly different from that of group B (P<0.01). The value of serum lactic acid of group A was significantly increased from the 15th day and significantly different from that of group B (P<0.01) from 15th to 28th day. Conclusion ScvO_2 can reflect the severity of patient's condition and serve as one of early prediction of prognosis. The degree of ScvO_2 decrease is remarkably correlated with the severity of disease. The mortality will increase when ScvO_2 is at a low level persistently. Furthermore, ScvO_2 change as a sensitive index occurs earlier than serum lactic acid.