标题：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

      作者：李晓，高伟芳，桑荣霞，张纪元，胡静，刘润，韩占波
    (石家庄市第一医院消化二科，河北 石家庄 050011)

      卷次： 2016年27卷10期

      【摘要】 目的 研究动静脉血气分析在重症胰腺炎(SAP)患者早期预后判断中的临床价值。方法 选取2012
年9月至2014年9月收入我院 ICU的SAP患者64例，以患者 ICU住院10 d为终点事件，根据预后情况将所有患者
分为存活组(好转或病情未恶化)及死亡组(患者死亡)，其中，存活组 36例，死亡组 28例。所有患者进行常规 ICU
治疗，发病 48 h内进行血气分析和电解质检查，并与APACHEⅡ评分结果比较。结果 发病 48 h内血气测定结
果表明，存活组和死亡组的动脉血 pH-静脉血 pH (A-VpH) [(0.022±0.09) vs (0.031±0.015)]、动脉血CO2分压-静脉
血 CO2分压(A-VPCO2) [(8.68±1.35) vs (11.48±4.56)]比较差异有统计学意义(P<0.05)，动静脉血 pH [(7.35±0.06) vs
(7.36±0.05)]及血 PO2水平[(95.3±8.9) mmHg vs (95.9±9.1) mmHg]比较差异无统计学意义(P>0.05)；与存活组比较，
死亡组血动静脉PCO2 [动脉：(35.3±3.0) mmHg vs (29.9±3.0) mmHg、静脉：(35.3±3.0) mmHg vs (29.9±3.0) mmHg]、血
HCO3- [动脉：(23.8±1.2) mmol/L vs (20.2±1.9) mmol/L、静脉：(17.5±1.0) mmol/L vs (19.3±1.2) mmol/L]、血Lac水平[动脉：
(2.7±0.9) mmol/L vs (4.1±1.7) mmol/L、静脉：(1.7±0.6) mmol/L vs (1.8±0.4) mmol/L]、血BE水平[动脉：(-1.7±1.2) mmol/L vs
(-4.3±1.6) mmol/L、静脉：(1.9±1.2) mmol/L vs (2.1±0.9) mmol/L]比较差异具有统计学意义(P<0.05)。发病 48 h内电
解质测定结果表明，存活组和死亡组的K+[(3.71±0.69) mmol/L vs (3.79±0.70) mmol/L]、Na+[(135.60±7.88) mmol/L vs
(134.32±7.94) mmol/L]、Cl-[(100.85±20.73) mmol/L vs (98.49±24.3) mmol/L]水平比较差异均无统计学意义(P>0.05)；
两组Ca2+水平均减少，与死亡组比较，存活组Ca2+显著降低[(1.47±0.50) mmol/L vs (1.22±0.38) mmol/L]，差异具有统
计学意义(P<0.05)。为进一步明确 PCO2、血HCO3-、血BE对 SAP患者预后的判断价值，ROC曲线统计 PCO2、血
HCO3-、血BE对SAP的预后的诊断正确率，得血BE及APACHEⅡ评分的ROC曲线面积最大，表明其诊断正确率
最高。结论 早期进行SAP患者的血气分析检测有利于及早判断预后，进行合理治疗。年龄越大，血BE结果负值
越大的患者，其预后可能也差。

      【关键词】 血气分析；重症胰腺炎；早期预后；判断

      【中图分类号】 R657.5+1 【文献标识码】 A 【文章编号】 1003—6350（2016）10—1582—03


Clinical value of blood gas analysis in the early prognosis of severe acute pancreatitis.
LI Xiao, GAO Wei-fang,
SANG Rong-xia, ZHANG Ji-yuan, HU jing, LIU Run, HAN Zhan-bo. The Second Department of Gastroenterology, the First
Hospital of Shijiazhuang City, Shijiazhuang 050011, Hebei, CHINA

【Abstract】 Objective To investigate the clinical value of blood gas analysis in the early stage of severe acute pan-
creatitis (SAP). Methods A total of 64 patients with SAP, who admitted to ICU of our hospital from September 2012 to Sep-
tember 2014, were enrolled in the study. With ICU stay of 10 d as the primary endpoint, the patients were divided into
survival group (36 cases, with remission or with no deterioration) and death group (28 cases, death). All patients were
treated by routine treatment in ICU. Blood gas analysis and electrolyte examination were carried out within 48 h, which
were compared with the results of APACHEⅡ. Results Blood gas test results within 48 h showed that there were sig-
nificant differences in arterial-venous blood pH (A-VpH) [(0.022±0.09) vs (0.031±0.015)] and arterial-venous blood CO2
levels (A -VPCO2) [(8.68±1.35) vs (11.48±4.56)] between survival group and death group (P<0.05), with no significant
differences in blood pH [(7.35±0.06) vs (7.36±0.05)] and blood PO2 levels [(95.3±8.9) mmHg vs (95.9±9.1) mmHg], P>0.05.
The two groups showed statistically significant differences in PCO2 [arterial: (35.3±3.0) mmHg vs (29.9±3.0) mmHg;
venous: (35.3±3.0) mmHg vs (29.9±3.0) mmHg], blood HCO3- [arterial: (23.8±1.2) mmol/L vs (20.2±1.9) mmol/L;
venous: (17.5±1.0) mmol/L vs (19.3±1.2) mmol/L], blood Lac [arterial: (2.7±0.9) mmol/L vs (4.1±1.7) mmol/L;
venous: (1.7±0.6) mmol/L vs (1.8±0.4) mmol/L mmol/L], blood BE [arterial: (-1.7±1.2) mmol/L vs (-4.3±1.6) mmol/L;
arterial: (1.9±1.2) mmol/L vs (2.1±0.9) mmol/L mmol/L] (P<0.05). There were no significant differences between the surviv-
al group and the death group in the levels of K+ [(3.71±0.69) mmol/L vs (3.79±0.70) mmol/L], Na+ [(135.60±7.88) mmol/L vs
(134.32±7.94) mmol/L], Cl- [(100.85±20.73) mmol/L vs (98.49±24.3) mmol/L] within 48 h (P>0.05). The Ca2 + levels in the
two groups were both decreased, and the level in the survival group was significantly lower than that in death group
[(1.47±0.50) mmol/L vs (1.22±0.38) mmol/L，P<0.05]. In order to determine the value of PCO2, HCO3- and BE in the
prognosis of patients with SAP, the ROC