Abstract：Objective To explore the clinical significance of the ratio of the central venous-arterial carbon dioxide partial pressure difference and the arterial-central venous oxygen content difference (Pv-aCO2/Ca-vO2) to early acute renal injury (AKI) in sepsis.Methods This study was a prospective and observative cohort study.A total of 48 patients with sepsis and mechanical ventilation in the intensive care unit of Foshan Second People Hospital were enrolled into this study and their general clinical data grading scores were collected from August, 2019 to January, 2020.According to whether AKI occurred 24 h after resuscitation, they were divided into AKI group (n=31) and non-AKI group (n=17).The capillary refill time (CRT), lactate (Lac), Pv-aCO2 and Ca-vO2 were collected at 0, 12 and 24 h after resuscitation.The potential influencing factors of AKI were analyzed by binary Logistic regression model, and then the risk factors were decided.Receiver operating characteristic curve (ROC) was used to analyze the predictive value of each indexs for AKI diagnostic value at the early stage of sepsis.Results The initial score of acute physiology and chronic health and the initial score of sequential organ failure in AKI group were higher than those in the non-AKI group, the differences were statistic significant(P＜0.05).At 24 h after resuscitation, the Lac level in the AKI group was higher than that of the non-AKI group, and the difference was statistically significance(P＜0.05);At 12 and 24 h after resuscitation, the CRT of AKI group were longer than those of the non-AKI group, the differences were statistically significant(P＜0.05);At 0, 12 and 24 h after resuscitation, the Pv-aCO2/Ca-vO2 of the AKI group were higher than those of non-AKI group, the differences were also statistically significant (P＜0.05).The results of binary Logistic regression analysis showed that the value of Pv-aCO2/Ca-vO2 (β=2.579, OR=13.181, 95%CI=1.048-165.708, P=0.046) was an independent risk factor of AKI in early sepsis.ROC curve showed that 24 h after resuscitation, the cutoff value of Pv-aCO2/Ca-vO2 was 1.625,the sensitivity was 83.9% while the specificity was 76.5%.Conclusion Oxygen metabolism assessment has important clinical significance for early AKI assessment during resuscitation.Among them, Pv-aCO2/Ca-vO2 has a good predictive value for the progression of AKI.
袁满涓；霍保善 . 氧代谢指标评估脓毒症早期急性肾损伤的临床意义[J]. 中国当代医药, 2020, 27(23): 10-13转20.
YUAN Man-juan；HUO Bao-shan. Clinical significance of oxygen metabolic index in the evaluation of early acute renal injury in sepsis. 中国当代医药, 2020, 27(23): 10-13转20.
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