老年脓毒症休克患者血清NT-proBNP、SCVO2、P(v-a)CO2的变化与预后的关系

摘要

目的 探究老年脓毒症休克患者血清N末端脑钠肽原(NT-proBNP)、中心静脉血氧饱和度(SCVO2)、动静脉二氧化碳分压差[P(v-a)CO2]水平在患者预后评估中的价值.方法 选取2015年3月至2016年7月肃宁县人民医院内科重症监护病房(IC U)收治的老年脓毒症休克患者94例作为观察组A,另选取80例非严重脓毒症患者作为观察组B,选取56例同期体检健康者作为对照组,采用电化学发光免疫法测定血清中NT-proBNP水平,利用血气分析仪测定患者PvCO2、PaCO2、SCVO2.采用Logistic回归性分析老年脓毒症休克患者预后影响因素,ROC曲线分析NT-proBNP、P(v-a)CO2、SCVO2的预后预测价值.结果观察组A血清中NT-proBNP水平高于观察B组、对照组,差异具有统计学意义(P<0.05);SCVO2水平低于观察B组,P(v-a)CO2水平高于观察B组,差异具有统计学意义(P<0.05).死亡组患者年龄、NT-proBNP、P(v-a)CO2、乳酸水平以及APACHEⅡ评分均高于存活组,差异有统计学意义(P<0.05);SCVO2低于存活组,差异有统计学意义(P<0.05).Logistic多因素回归分析显示NT-proBNP、P(v-a)CO2、SCVO2是影响老年脓毒症休克患者预后的危险因素.受试者工作特征曲线(ROC曲线)显示P(v-a)CO2 AUC值、灵敏度高于NT-proBNP、SCVO2.结论 血清 NT-proBNP、SCVO2 、P(v-a)CO2 水平与老年脓毒症休克患者预后相关 ,其中P(v-a)CO2 对其预后评估价值较高 ,具有较好的临床价值.%Objective To explore relationship between the change of serum N terminal brain natriuretic peptide (NT-proBNP) , central venous oxygen saturation (SCVO2 ) and venous-arterial partial pressure of carbon dioxide [P(v-a)CO2 ] levels and prognosis in elderly patients with septic shock .Methods 94 cases of elderly patients with septic shock ,treated from March 2015 to July 2016 in Intensive Care Unit (ICU) of our hospital ,were chosen as the observation group A ,another 80 cases of nonsevere sepsis patients were chosen as the observation group B ,and a total of 56 patients healthy volunteers with the physical examination at the same peri-od of time in our hospital as normal control group .The serum NT-proBNP level was detected by electrochemiluminescence immuno-assay ,and PvCO2 ,PaCO2 and SCVO2 levels were detected by blood gas analyzer .records of patients with central venous blood car-bon dioxide .The NT-proBNP and P (v-a) CO2 levels in the serum of the three groups were compared between the groups of pa-tients in the observation group (SCVO2 ) .Logistic regression analysis was used to analyze the prognostic factors in elderly patients with septic shock ,and the receiver operating characteristic curve (ROC) was used to analyze the predictive value of NT-proBNP ,P (v-a)SCVO2 and SCVO2 levels .Results The serum NT-proBNP level of the observation group A was higher than that in the the observation group B and the control group (P<0 .05) .The SCVO2 level of the A group was lower than that in the B group ,and the P(v-a)CO2 level of the A group was higher than that in the B group ,the difference was statistically significant (P<0 .05) .The age , NT-proBNP ,P(v-a)CO2 ,lactic acid level and APACHE II score in the death group were higher than those in the survival group , and the difference was statistically significant (P< 0 .05) .SCVO2 level in the death group was lower than that in the survival group ,and the difference was statistically significant (P<0 .05) .Logistic multivariate regression analysis showed that NT-proBNP , P(v-a)CO2 and SCVO2 levels were the risk factors for the prognosis of elderly patients with septic shock .ROC curve showed AUC and the sensitivity of P(v-a)CO2 were higher than those of NT-proBNP ,SCVO2 .Conclusion The levels of serum NT-proBNP ,SC-VO2 and P(v-a)CO2 are related to the prognosis of elderly patients with septic shock ,and P(v-a)CO2 has a high value in the prog-nosis of the patients with septic shock ,and has a good clinical value .