摘要
目的观察老年感染性休克患者早期目标指导治疗(EGDT)过程中的胃黏膜pH值(pHi)变化,探讨其与疾病严重程度和预后的关系。方法45例老年感染性休克患者入选并进行EGDT,根据EGDT达标情况将患者分为达标组和未达标组,观察EGDT前后两组患者pHi、中心静脉血氧饱和度(ScvO2)和24h后患者急性生理和慢性健康评分(ApacheⅡ评分)变化,比较两组患者的28d生存率;其后将EGDT前后患者pHi与ScvO2、ApacheⅡ评分作相关分析。结果EGDT达标组患者治疗后pHi和ScvO2分别为7.092±0.17、0.619±0.040,较治疗前(7.205±0.145、0.697±0.156)均明显升高(均P<0.01)、ApacheⅡ评分较治疗前明显降低(P<0.01);而EGDT未达标组治疗前后各指标变化无统计学意义(均P>0.05)。达标组28d生存率(81.6%)明显高于未达标组(0)(P<0.01)。EGDT前达标组患者中28d生存者的pHi和ScvO2分别为7.121±0.168、0.626±0.037,较28d内死亡者高(6.964±0.119、0.588±.0437);EGDT后达标组患者中28d生存者pHi为7.256±0.101,较28d内死亡者(6.978±0.069)显著增高(P<0.01),而ScvO2无变化。EGDT前后,达标组患者pHi与ScvO2均呈显著正相关(r治疗前=0.629、0.320,P<0.01、0.05;r治疗后=0.456、0.551,均P<0.01)。结论pHi可以用于评价老年感染性休克患者EGDT效果、判断疾病严重程度,是有价值的临床指标。
Objective To evaluate the application of gastric intramucosal pH （pHi） in elderly patients with septic shock undergoing early goal-directed therapy （EGDT）. Methods Forty-five elderly patients with septic shock were enrolled and underwent EGDT, who were divided into goals achieved group and goals unachieved group, pHi and ScvO2 of both groups were measured at beginning and after EGDT. The Acute Physiology and Chronic Health Evaluation Ⅱ （Apache Ⅱ） score was calculated at the beginning and 24h after of EGDT; the 28-day survival was also compared between two groups. Correlation analysis was carried out to evaluate the relationship of pHi with ScvO2 and Apache Ⅱ score. Results In goals achieved group, the pHi and ScvO2 were significantly increased after EGDT in comparison with beginning of EGDT, and Apache Ⅱ score was significantly decreased. In goals unachieved group, there was no difference in pHi, ScvO2 and Apache Ⅱ score during EGDT. The 28-day survival was higher in goals achieved group compared to that of goals unachieved group （81.6% vs 0%, P〈0.01）. In goals achieved group, the 28-day survivors had higher pHi and ScvO2 before EGDT compared to those who died within 28 days （pHi, 7.121 ± 0.168 vs 6.964 ± 0.119; ScvO2, 0.626 ± 0.037 vs 0.588 ± .0437, P 〈0.05）;After EGDT, pHi of the survivors was significantly higher than that of fatal cases （7.256 ± 0.101vs 6.978 ± 0.069, P〈0.01）, while there was no difference in ScvO2 between two groups. The pHi in goals achieved group was positively correlated with ScvO2 and negatively correlated with Apache Ⅱ score with coefficient of 0.629, -0.509 on beginning of EGDT and 0.456, -0.461 after EGDT, respectively. Conclusion pHi is a valuable clinical parameter in evaluation of EGDT effect in elderly patients with septic shock and is also of value in judgment of disease severity.
出处
《浙江医学》
CAS
2008年第3期210-212,215,共4页
Zhejiang Medical Journal
基金
浙江省医药卫生重点科技资助项目(2004ZD002)
