BMC Anesthesiol:外周灌注指数预测手术患者ICU住院时间延长早于且优于乳酸:观察性研究

2020-06-30 anesthGH “罂粟花”微信号

背景与目的

背景与目的

外周灌注指数(PPI)是反映血流灌注的指标。接受长时间手术的患者更容易出现灌注不足和乳酸升高。然而,却很少有研究关注PPI与手术患者预后的关系。为了找出答案,我们进行了这项研究。

方 法

我们回顾了从2019年1月至2019年9月所有转移到某医院ICU的手术患者。纳入标准:年龄≥18岁;手术时间≥120 min。排除标准:死于ICU;违抗医嘱出院;存在影响上肢血流的疾病,如手臂血管血栓;严重肝功能障碍。将ICU住院时间(ICU LOS)超过48 h的患者定义为“ICU滞留时间延长”,并根据定义将患者分为“延长组”(PG)和“非延长组”(NPG)。收集基线特征、手术和治疗信息、ICU LOS、SOFA和APACHE II。记录入科后3个时间点(T0:入ICU时;T1:入ICU后6 h;T2:入ICU 后12 h) 的平均动脉压(MAP)、乳酸、心率(HR)、PPI、体温等数据。对两组数据进行比较。应用逻辑回归模型和ROC曲线分析灌注指标与ICU LOS的关系。

结 果

本研究共纳入168例患者,其中PG组65例,NPG组103例。与NPG组相比,PG组患者的血乳酸水平较高,PPI较低。两组患者间的PPI差异均早于乳酸(T0 vs T1)。PG组两个时间点的PPI值均低于NPG组(T0: 1.09 ± 0.33 vs 1.41 ± 0.45, p = 0.001; T1: 1.08 ± 0.37 vs 1.49 ± 0.41, p < 0.001)。T1时乳酸增加(OR :3.216;95%CI :1.253~8.254,P=0.015)和PPI降低(OR:0.070;95%CI :0.016~0.307,P<0.001)是ICU患者住院时间延长的独立相关因素。T1时,PPI 预测ICU住院时间>48 h的ROC下面积为0.772,PPI的临界值为1.35,敏感性为83.3%,特异性为73.8%。

结 论

T1时(入ICU后6h),PPI和血乳酸与手术患者ICU LOS相关。与乳酸相比,PPI能更早地提示灌注不足,更准确地预测患者ICU住院时间延长。

原始出处:

Shi X, Xu M, Yu X, et al. Peripheral perfusion index predicting prolonged ICU stay earlier and better than lactate in surgical patients: an observational study.[J] .BMC Anesthesiol, 2020, 20: 153.

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    2020-07-02 skhzy