The Clinical Study Of Oxygen Metabolism Rate In The Prognosis Of Patients With Sepsis In ICU

Objective:To explore the correlation between oxygen metabolism and blood lactase clearance rate,SCVO2 and cardiac index,and analyze its relationship with prognosis in the early stage(the 24 th hour,48 th hour,72 th hour)of patients with sepsis in ICU.Methods:In this paper,a retrospective analysis was conducted.Patients of Tianjin Third Central Hospital in January 2014-December 31,2017,admitted to the intensive care unit(ICU),and a diagnosis of sepsis,and the length of time more than 72 nd hour were taken as the research objects.All patients meet the standard of which,in February,2016,in the annual meeting of the 45 th session of critical care medicine,the intensive society of America(SCCM)and the European critical care medicine(ESICM)jointly issued SEPSIS 3.0(SEPSIS 3.0)definition and diagnosis.Through screening,69 valid cases were selected in the end,of which male patients 38 cases,female patients 31 cases.The observation ending point is when the patient left ICU,where patients were divided into the survival group and the death group according to their state.The survival group included 34 patients,and the death group included 35.All patients were given life support and active treatment of primary disease.By reviewing the medical records,all patients were admitted to the hospital with the APACHE ? score and SOFA score,as well as their gender,age,body temperature,average arterial pressure(MAP),blood routine,liver and kidney function.All patients were hospitalized with a femoral artery catheter and superior vena cava catheter(the superior vena cava was identified in the right atrium).At 0th hour(immediately after femoral artery catheterization),the femoral artery and venous blood samples were extracted,and the blood gas analysis was performed.The central venous oxygen saturation(SCVO2)and arterial oxygen saturation(SaO2)were obtained.According to the formula of oxygen metabolism rate = 1-scvo2 /SaO2,the oxygen metabolism rate was calculated when accessing group(0th hour).At the 24 th hour,48 th hour,and 72 nd hour respectively,the femoral artery was collected for arterial blood gas analysis,measure arterial blood oxygen content,blood oxygen saturation,blood lactic acid value.Meanwhile,venous blood was taken at the above time point and blood gas analysis was performed to determine SCVO2,blood lactic acid value,and to calculate the 24 th hour,48 th hour,and 72 nd hour of oxygen metabolism.According to the blood lactic acid,lactate clearance rate(lactate clearance rate =(initial concentration of lactic acid-corresponding time blood lactic acid concentration)/ initial concentration of lactic acid(100%)at 24 th hour,48 th hour,72 nd hour was calculated,and by using the pulse contour temperature diluted continuous cardiac output monitoring technology(PICCO),all patients at 0 hour,24 th hour,48 th hour and 72 nd hour of cardiac index(CI)were monitored.By comparing two groups of patients respectively with different period of oxygen metabolism,blood lactic acid,lactic acid clearance,SCVO2 and CI,by comparing the correlation of various parameters to evaluate the prognosis of judgment,according to the area under the ROC curve determine the indexes to evaluate the prognosis of ability,after using logistic regression with multiple factors,the area under the ROC curve was calculated to determine the indexes and to evaluate the prognosis ability.Results: The oxygen metabolism rate,lactate clearance rate and CI value at different time were all lower than the survival group at different time periods of the death group,and the difference was statistically significant(P<0.05).At different time,SCVO2 and blood lactic acid value of death group were both higher than survival group,and the difference was statistically significant(P<0.05).In the death group,APACHE ? score and SOFA score were higher than the survival group,which means the difference was statistically significant(P<0.01);mechanical ventilation time in death group was higher than in survival group,which means the difference was statistically significant(P<0.05).0-hour oxygen metabolism rate was negatively correlated with SCVO2(r=-0.956 P < 0.01)and with PvO2(r=-0.604 P < 0.01).The 24 th hour oxygen metabolism rate and SOFA score(r=-0.238 P < 0.05),SCVO2(r=-0.972 P < 0.01),PvO2(r=-0.357 P < 0.01)were negatively correlated but were positively correlated with HB(r= 0,267 P < 0.05).48 thhour oxygen metabolism rate and SOFA score(r = 0.238,P < 0.05),APACHE ? score(r = 0.245,P < 0.05),SCVO2(r = 0.977,P < 0.01),PvO2(r = 0.452,P < 0.01),blood lactate acid value(r = 0.273,P < 0.05),the mechanical ventilation time(r = 0.315,P < 0.01)were negatively correlated,but were positively correlated with SaO2(r = 0.338,P < 0.01)and lactate acid clearance(r = 0.249,P < 0.05).72 ndhour oxygen metabolism rate was negatively correlated with SOFA score(r=-0.490 P<0.01),APACHE ? score(r=-0.612 P<0.01),SCVO2(r=-0.958 P<0.01),blood lactate acid value(r=-0.691 P<0.01),mechanical ventilation time(r=-0.264 P<0.05),but positively correlated with lactate clearance(r=0.545 P<0.01),CI(r=0.398 P<0.01).Conclusions: At the early phase of sepsis,oxygen metabolism,lactate clearance rate,blood lactic acid value,APACHE ? score,SOFA score,both can be used as a prognostic indicator,72 nd hour of oxygen metabolism rate of sepsis prognostic judgment is better than that of all the indicators,may become the ICU an independent predictor of prognosis of patients with sepsis in the hospital.Compared with the data collection and calculation of the APACHE ? and SOFA scores,the 72 nd hour oxygen metabolism rate was more sensitive and accurate to the prognosis of ICU sepsis.