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
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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(PO_2)、二氧化碳分压(PCO_2)、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PCO_2、HCO-3、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PO_2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。
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( PO_2),partial pressure of carbon dioxide( PCO_2),pH value,bicarbonate ion( HCO-3),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 PCO_2,HCO-3,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 PO_2 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 Ⅱscore 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.
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( PO_2),partial pressure of carbon dioxide( PCO_2),pH value,bicarbonate ion( HCO-3),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 PCO_2,HCO-3,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 PO_2 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 Ⅱscore 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.
引文
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[14]Sano H,Komasawa N,Konishi Y,et al.Comparison of Pa O2and Pa CO2in arterial blood gas analysis between Eco LiteTMand conventional medium concentration face mask[J].Am J Emerg Med,2017,35(5):795-796.
[15]张春雨,李蕊,张大程,等.脐血血气分析在早产儿窒息诊断中的价值及影响因素分析[J].中国妇幼保健,2017,32(5):968-971.
[16]徐玉善,张文华,李红.糖尿病酮症酸中毒的诊治[J].中华内科杂志,2017,56(4):305-306.
[17]何咏梅,尹邦燕,杨中顺,等.皮下胰岛素泵治疗糖尿病酮症酸中毒疗效及对氧化应激的影响[J].陕西医学杂志,2016,45(6):751-753.
[18]李晓,高伟芳,桑荣霞,等.动静脉血气分析在重症胰腺炎患者早期预后判断中的临床价值[J].海南医学,2016,27(10):1582-1584.
[19]Kozacl N,Ay MO,Güven R,et al.Comparison of Na,K,Cl,Hb and Hct values measured by blood gas analyzer and laboratory auto-analyzer[J].Türk Biyokimya Dergisi,2015,40(4):343-347.
[20]Mohan N,Gireesh KKP,Sreekrishnan TP,et al.Can venous blood gases replace arterial blood gases in diabetic ketoacidosis/renal failure induced metabolic acidosis?[J].UJMSJ,2015,3(3):65-69.
[21]于闯,张振宝.慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者有创机械通气治疗中血气指标控制对预后的影响[J].中国呼吸与危重监护杂志,2015,14(2):132-134.
[22]董燕,程蔚.脐动脉血气分析对评价新生儿窒息及预后的临床研究[J].中国优生与遗传杂志,2015,23(1):79-81,99.
[23]赵燕凤,张志群,芦蕙,等.脐动脉血气分析联合Apgar评分对新生儿窒息多器官损害的诊断意义[J].中华全科医学,2017,15(2):267-269.
[24]Rasheed JI,Razak MKA,Hussein AAA.The value of venous blood gas analysis in the diagnosis of diabetic ketoacidosis[J].Diabetes Metab Syndr,2017,11 Suppl 2:S737-S743.
[25]张春林,刘刚,童强,等.糖尿病酮症酸中毒住院患者的预后因素分析[J].第三军医大学学报,2017,39(16):1659-1663.
[2]王旭东.重视糖尿病酮症酸中毒并发症[J].中国临床医生杂志,2017(1):1-3,129.
[3]李光荣,郭天虹,周明术,等.某院血气分析危急值情况回顾分析与评估[J].检验医学与临床,2016,13(6):842-844.
[4]翟笑,肖新华.糖尿病酮症酸中毒的救治及进展[J].临床内科杂志,2017,34(3):152-154.
[5]田玉先,王冬梅,任平香,等.静脉血气分析在糖尿病酮症酸中毒患者中的应用价值[J].河北医科大学学报,2015,36(1):79-81.
[6]陈禺溪,刘曹杰,张雨薇.2016年糖尿病重要临床进展回顾[J].中国实用内科杂志,2017,37(4):322-325.
[7]葛勤敏,潘曙明.《中国糖尿病血酮监测专家共识》解读[J].糖尿病临床,2016,10(6):263-267.
[8]Simpson LO.How does antidepressant medication relate to the pathophysiology of depression?[J].Diabet Med,2015,29(1):32-35.
[9]孙鑫.不同部位动脉采血进行血气分析的临床效果观察[J].中国医药指南,2017,15(6):53.
[10]杨颖,高凌.外周静脉血气分析在糖尿病酮症酸中毒及终末期糖尿病肾脏疾病中的应用[J].临床内科杂志,2017,34(8):532-534.
[11]Carluccio A,Contri A,Gloria A,et al.Correlation between some arterial and venous blood gas parameters in healthy newborn Martina Franca donkey foals from birth to 96 hours of age[J].Theriogenology,2017,87:173-178.
[12]Jeong DH,Yang JJ,Lee L,et al.Prediction of arterial blood gas values from venous blood gas values in Asiatic black bears(Ursus thibetanus)anesthetized with intramuscular medetomidine and zolazepam-tiletamine[J].J Vet Med Sci,2017,79(10):1757-1763.
[13]Boulain T,Garot D,Vignon P,et al.Predicting arterial blood gas and lactate from central venous blood analysis in critically ill patients:a multicentre,prospective,diagnostic accuracy study[J].Br J Anaesth,2016,117(3):341-349.
[14]Sano H,Komasawa N,Konishi Y,et al.Comparison of Pa O2and Pa CO2in arterial blood gas analysis between Eco LiteTMand conventional medium concentration face mask[J].Am J Emerg Med,2017,35(5):795-796.
[15]张春雨,李蕊,张大程,等.脐血血气分析在早产儿窒息诊断中的价值及影响因素分析[J].中国妇幼保健,2017,32(5):968-971.
[16]徐玉善,张文华,李红.糖尿病酮症酸中毒的诊治[J].中华内科杂志,2017,56(4):305-306.
[17]何咏梅,尹邦燕,杨中顺,等.皮下胰岛素泵治疗糖尿病酮症酸中毒疗效及对氧化应激的影响[J].陕西医学杂志,2016,45(6):751-753.
[18]李晓,高伟芳,桑荣霞,等.动静脉血气分析在重症胰腺炎患者早期预后判断中的临床价值[J].海南医学,2016,27(10):1582-1584.
[19]Kozacl N,Ay MO,Güven R,et al.Comparison of Na,K,Cl,Hb and Hct values measured by blood gas analyzer and laboratory auto-analyzer[J].Türk Biyokimya Dergisi,2015,40(4):343-347.
[20]Mohan N,Gireesh KKP,Sreekrishnan TP,et al.Can venous blood gases replace arterial blood gases in diabetic ketoacidosis/renal failure induced metabolic acidosis?[J].UJMSJ,2015,3(3):65-69.
[21]于闯,张振宝.慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者有创机械通气治疗中血气指标控制对预后的影响[J].中国呼吸与危重监护杂志,2015,14(2):132-134.
[22]董燕,程蔚.脐动脉血气分析对评价新生儿窒息及预后的临床研究[J].中国优生与遗传杂志,2015,23(1):79-81,99.
[23]赵燕凤,张志群,芦蕙,等.脐动脉血气分析联合Apgar评分对新生儿窒息多器官损害的诊断意义[J].中华全科医学,2017,15(2):267-269.
[24]Rasheed JI,Razak MKA,Hussein AAA.The value of venous blood gas analysis in the diagnosis of diabetic ketoacidosis[J].Diabetes Metab Syndr,2017,11 Suppl 2:S737-S743.
[25]张春林,刘刚,童强,等.糖尿病酮症酸中毒住院患者的预后因素分析[J].第三军医大学学报,2017,39(16):1659-1663.