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中国临床研究:2018,31(6):789-792
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静脉血气分析在糖尿病酮症酸中毒患者预后判断中的临床价值
(中山大学附属第八医院(深圳福田)内分泌科,广东 深圳 518033)
Value of venous blood gas analysis in prognosis of patients with diabetic ketoacidosis
(Department of Endocrinology, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen,Guangdong 518033, China)
摘要
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投稿时间:2018-01-22   网络发布日期:2018-06-21
中文摘要: 目的 探讨静脉血气分析在糖尿病酮症酸中毒患者中的应用及其对患者预后判断的临床价值。方法 选取入住ICU的108例糖尿病酮症酸中毒患者为研究对象,均接受常规ICU治疗,并于发病48 h内进行静脉血气分析,以患者随访28 d为终点,根据患者预后情况,将病情好转者或病情未恶化者纳入存活组(92例),死亡者纳入死亡组(16例)。比较两组患者血气分析氧分压(PO2)、二氧化碳分压(PCO2)、pH值、碳酸氢根离子(HCO3-)、碱剩余(BE),并分析上述指标与急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分的相关性。结果 存活组患者血PCO2、HCO3-、BE水平及APACHEⅡ评分明显低于死亡组,差异均有统计学意义(P<0.05,P<0.01),但两组PO2及pH值比较无统计学差异(P>0.05);由ROC曲线图可知,血BE和APACHEⅡ评分的ROC曲线下面积最大,提示二者对糖尿病酮症酸中毒预后的诊断正确率最高;Pearson相关性分析结果提示,血BE与APACHEⅡ评分呈正相关(r=0.584,P=0.007),提示糖尿病酮症酸中毒患者血液中BE水平越低,其患者的APACHEⅡ评分也越低。结论 静脉血气分析具有操作简单的优势。对糖尿病酮症酸中毒患者行早期静脉血气分析,利于对其预后的判断,血BE水平越低的患者,其APACHEⅡ评分越低,预后可能越好。
Abstract:Objective To evaluate the clinical value of venous blood gas analysis in predicting the prognosis of patients with diabetic ketoacidosis. Methods A total of 108 patients with diabetic ketoacidosis hospitalized in intensive care unit(ICU) were selected and received routine ICU admission. Blood gas analysis was performed within 48 hours after onset. Patients were followed up for 28 days. According to the prognosis during follow-up, the patients were enrolled in survival group (improved or were not deteriorated, n=92) and in death group (n=16). The partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), pH value, bicarbonate ion (HCO3-), base excess (BE) were measured and compared between two groups, and the correlation between the above indicators and the acute physiology and chronic health status scoring system (APACHE Ⅱ) were analyzed. Results The levels of PCO2, HCO3-, BE and APACHEⅡ score in survival group were significantly lower than those in death group (all P<0.05), but there were no significant differences in PO2 and pH value between two groups (P>0.05). Receive operator characteristic (ROC)curve showed that area under curves (AUC) of BE and APACHE Ⅱ score were the largest, suggesting the highest diagnosis rate of BE and APACHE Ⅱ score for diabetic ketoacidosis prognosis. Pearson correlation analysis showed that BE was positively correlated with APACHEⅡ score (r=0. 584, P=0. 007), namely, the lower the level of BE in blood of patients with diabetic ketoacidosis, the lower APACHEⅡ score. Conclusions Venous blood gas analysis has the advantage of simple operation. For patients with diabetic ketoacidosis, early venous blood gas analysis is beneficial to judging the prognosis. The lower the level of blood BE, the lower the APACHE II score, the better the prognosis.
文章编号:     中图分类号:R 587.2    文献标志码:B
基金项目:深圳市福田区卫生公益性科研资助项目(FTWS201314)
引用文本:
叶艺艺,庄雄杰,蒋凤秀,桑丹.静脉血气分析在糖尿病酮症酸中毒患者预后判断中的临床价值[J].中国临床研究,2018,31(6):789-792.

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