动静脉血气分析在重症胰腺炎患者早期预后判断中的临床价值

目的：研究动静脉血气分析在重症胰腺炎(SAP)患者早期预后判断中的临床价值。方法选取2012年9月至2014年9月收入我院ICU的SAP患者64例，以患者ICU住院10 d为终点事件，根据预后情况将所有患者分为存活组(好转或病情未恶化)及死亡组(患者死亡)，其中，存活组36例，死亡组28例。所有患者进行常规ICU治疗，发病48 h内进行血气分析和电解质检查，并与APACHEⅡ评分结果比较。结果发病48 h内血气测定结果表明，存活组和死亡组的动脉血pH-静脉血pH (A-VpH)(0.022±0.09) vs (0.031±0.015)]、动脉血CO2分压-静脉血CO2分压(A-VPCO2)(8.68±1.35) vs (11.48±4.56)]比较差异有统计学意义(P<0.05)，动静脉血pH (7.35±0.06) vs (7.36±0.05)]及血PO2水平(95.3±8.9) mmHg vs (95.9±9.1) mmHg]比较差异无统计学意义(P>0.05)；与存活组比较，死亡组血动静脉PCO2动脉：(35.3±3.0) mmHg vs (29.9±3.0) mmHg、静脉：(35.3±3.0) mmHg vs (29.9±3.0) mmHg]、血HCO3-动脉：(23.8±1.2) mmol/L vs (20.2±1.9) mmol/L、静脉：(17.5±1.0) mmol/L vs (19.3±1.2) mmol/L]、血Lac水平动脉：(2.7±0.9) mmol/L vs (4.1±1.7) mmol/L、静脉：(1.7±0.6) mmol/L vs (1.8±0.4) mmol/L]、血BE水平动脉：(-1.7±1.2) mmol/L vs (-4.3±1.6) mmol/L、静脉：(1.9±1.2) mmol/L vs (2.1±0.9) mmol/L]比较差异具有统计学意义(P<0.05)。发病48 h内电解质测定结果表明，存活组和死亡组的K+(3.71±0.69) mmol/L vs (3.79±0.70) mmol/L]、Na+(135.60±7.88) mmol/L vs (134.32±7.94) mmol/L]、Cl-(100.85±20.73) mmol/L vs (98.49±24.3) mmol/L]水平比较差异均无统计学意义(P>0.05)；两组Ca2+水平均减少，与死亡组比较，存活组Ca2+显著降低(1.47±0.50) mmol/L vs (1.22±0.38) mmol/L]，差异具有统计学意义(P<0.05)。为进一步明确PCO2、血HCO3-、血BE对SAP患者预后的判断价值，ROC曲线统计PCO2、血HCO3-、血BE对SAP的预后的诊断正确率，得血BE及APACHEⅡ评分的ROC曲线面积最大，表明其诊断正确率最高。结论早期进行SAP患者的血气分析检测有利于及早判断预后，进行合理治疗。年龄越大，血BE结果负值越大的患者，其预后可能也差。

Clinical value of blood gas analysis in the early prognosis of severe acute pancreatitis

Objective To investigate the clinical value of blood gas analysis in the early stage of severe acute pan-creatitis (SAP). Methods A total of 64 patients with SAP, who admitted to ICU of our hospital from September 2012 to Sep-tember 2014, were enrolled in the study. With ICU stay of 10 d as the primary endpoint, the patients were divided into survival group (36 cases, with remission or with no deterioration) and death group (28 cases, death). All patients were treated by routine treatment in ICU. Blood gas analysis and electrolyte examination were carried out within 48 h, which were compared with the results of APACHEⅡ. Results Blood gas test results within 48 h showed that there were sig-nificant differences in arterial-venous blood pH (A-VpH) (0.022±0.09) vs (0.031±0.015)] and arterial-venous blood CO2 levels (A-VPCO2) (8.68 ± 1.35) vs (11.48 ± 4.56)] between survival group and death group (P<0.05), with no significant differences in blood pH (7.35±0.06) vs (7.36±0.05)] and blood PO2 levels (95.3±8.9) mmHg vs (95.9±9.1) mmHg], P>0.05. The two groups showed statistically significant differences in PCO2 arterial:(35.3 ± 3.0) mmHg vs (29.9 ± 3.0) mmHg;venous:(35.3 ± 3.0) mmHg vs (29.9 ± 3.0) mmHg], blood HCO3-arterial:(23.8 ± 1.2) mmol/L vs (20.2 ± 1.9) mmol/L;venous: (17.5±1.0) mmol/L vs (19.3±1.2) mmol/L], blood Lac arterial: (2.7±0.9) mmol/L vs (4.1±1.7) mmol/L;venous:(1.7±0.6) mmol/L vs (1.8±0.4) mmol/L mmol/L], blood BE arterial:(-1.7±1.2) mmol/L vs (-4.3±1.6) mmol/L;arterial:(1.9±1.2) mmol/L vs (2.1±0.9) mmol/L mmol/L] (P<0.05). There were no significant differences between the surviv-al group and the death group in the levels of K+(3.71 ± 0.69) mmol/L vs (3.79 ± 0.70) mmol/L], Na+(135.60 ± 7.88) mmol/L vs (134.32±7.94) mmol/L], Cl-(100.85±20.73) mmol/L vs (98.49±24.3) mmol/L] within 48 h (P>0.05). The Ca2+levels in the two groups were both decreased, and the level in the survival group was significantly lower than that in death group (1.47 ± 0.50) mmol/L vs (1.22 ± 0.38) mmol/L,P<0.05]. In order to determine the value of PCO2, HCO3-and BE in the prognosis of patients with SAP, the ROC curves were used to calculate the accuracy rate of prognosis of patients with SAP. The area under the ROC curve of BE and APACHEⅡscore was the largest, which indicated the highest diagnostic accuracy. Conclusion The early detection of blood gas analysis in patients with SAP is more conducive to the judg-ment of prognosis. The prognosis of patients with bigger negative BE score and older age may be poor.