CO2结合力对肝硬化食管胃静脉出血休克患者预后的判断价值

目的利用ROC曲线评价CO₂结合力(carbondioxide combining power,CO₂-CP)对肝硬化食管胃静脉曲张破裂出血失血性休克患者预后的判断价值。方法收集2018年6月—2019年6月我中心重症医学科收治的107例肝硬化食管胃静脉曲张出血休克患者的临床资料,根据临床转归将其分为生存组和死亡组,评估生存组和死亡组CO₂-CP和碱剩余(base excess,BE)的水平,应用Spearman法对CO₂-CP和BE进行相关性分析,应用AUC评估CO₂-CP和BE对预后的判断价值。结果生存组BE的平均水平为(-1.41±6.00)mmol/L,死亡组BE的平均水平为(-15.93±4.44)mmol/L,2组相比差异有统计学意义(t=8.570,P=0.000)。生存组CO₂-CP的平均水平为(20.36±4.35)mmol/L,死亡组CO₂-CP的平均水平为(10.07±2.49)mmol/L,2组相比差异有统计学意义(t=8.607,P=0.000)。CO₂-CP和BE呈正相关(r=0.875,P=0.000)。CO₂-CP和BE针对预后的AUC分别为0.871,0.922,95%CI分别为0.770~0.972,0.846~0.998,差异均无统计学意义(P均>0.05)。结论CO₂-CP可较好地反映肝硬化食管胃静脉曲张破裂出血失血性休克患者代谢性酸中毒水平和预后预测。

Effect of CO2 combining power on predicting prognosis of patients with shock caused by cirrhotic esophageal and gastric variceal bleeding

Objective To evaluate and compare the predictive power of carbon dioxide combining power(CO₂-CP)on the prognosis of patients with hemorrhagic shock caused by cirrhotic esophageal and gastric variceal bleeding by using ROC curve.Methods Clinical data of 107 patients with hemorrhagic shock caused by cirrhotic esophageal and gastric variceal bleeding,who were admitted to critical Care Department of Fifth Medical Center of Chinese PLA General Hospital from June 2018 to June 2019,were collected.The included patients were divided into survival group and death group according to their clinical outcome.The levels of CO₂-CP and base excess(BE)in the survival group and the death group were assessed.Spearman method was used to perform correlation analysis of CO₂-CP and BE,and AUC was used to assess the predictive powers of CO₂-CP and BE to clinical outcome.Results The mean level of BE in survival group was(-1.41±6.00)mmol/L and that in death group was(-15.93±4.44)mmol/L,with statistically significant difference between 2 groups(t=8.570,P=0.000).The mean level of CO₂-CP in survival group was(20.36±4.35)mmol/L and that in death group was(10.07±2.49)mmol/L,with statistically significant difference between 2 groups(t=8.607,P=0.000).CO₂-CP is positively correlated with BE(r=0.875,P=0.000).The AUC of CO₂-CP and BE for predicting prognosis were 0.871 and 0.922(95%CI:0.770-0.972,0.846-0.998),respectively,and there was no statistically significant difference(P>0.05).Conclusions CO₂-CP is a good index to reflect the severity of metabolic acidosis and predict the prognosis of patients with hemorrhagic shock caused by cirrhotic esophageal and gastric variceal bleeding.