The Clinical Application Of Transcutaneous Partial Pressure Of Oxygen In Patients With Septic Shock

Background: Septic shock is currently one of the subtypes of sepsis,characterized by rapid onset,rapid deterioration,and high fatality rate,with a mortality rate of 24.2% to 32%.At present,the clinicians judge the lack of hypoxia and organ perfusion and usually adopt monitoring indicators such as arterial oxygen saturation and lactic acid.To judge the severity of disease in patients with using APACHE ? score,but they also shortcomings.Percutaneous oxygen partial pressure and CO₂ monitoring with non-invasive,sustainability,and can dynamically reflect the characteristics of the metabolism of oxygen and carbon dioxide,and provide reference for clinical doctors to judge tissue perfusion.Objective: Collect in the arterial blood oxygen partial pressure and partial pressure of carbon dioxide and lactic acid value,parallel APACHE ? score,study the monitoring indicators with percutaneous organizations in adult patients with septic shock if there is a correlation between,whether can be used to evaluate the surrounding tissue perfusion delivery situation and rapid evaluation of the patient's disease severity.Methods: From June 2017 to January 2018,36 patients with septic shock in the severe medical science?ICU?in Qingdao municipal hospital?east hospital?were collected.Respectively in the diagnosis of patients with septic shock 4 h,24 h,48 h lines of arterial blood gas analysis and percutaneous oxygen/carbon dioxide partial pressure monitoring,and line 4 h in patients admitted to hospital with APACHE ? score.Record patients' 4 h,24 h,48 h arterial oxygen partial pressure?PaO₂?,arterial partial pressure of carbon dioxide?Pa CO₂?,percutaneous tissue oxygen partial pressure?PtcO₂?,percutaneous tissue CO₂ partial pressure?Ptc CO₂?,lactic acid?Lac?numerical and 4 h of admission APACHE ? score.Calculation: oxygen partial pressure difference=PaO₂-PtcO₂,carbon dioxide partial pressure difference=Ptc CO₂-Pa CO₂,oxygen partial pressure deviation =?PtcO₂-Pa02?/PaO₂ and carbon dioxide partial pressure offset =?Ptc CO₂-Pa CO₂?/Pa CO₂.According to the lactic acid value of 4h in the hospital,the group was higher than 4mmol/L,and less than 4mmol/L was the low lactate group.Based on 4 h of admission APACHE ? score,or more than 20 points for the high APACHE ? group,not less than 20 points for the low APACHE ? group.The correlation between the PaO₂ of 4h,24 h and 48 h,the difference between PaO₂ and PtcO₂,oxygen partial pressure and oxygen partial pressure,and the correlation between Pa CO₂ and Ptc CO₂,carbon dioxide partial pressure difference and carbon dioxide partial pressure deviation.Comparison of 4 h PaO₂,PtcO₂,difference of oxygen partial pressure,oxygen partial pressure deviation degree,Pa CO₂,Ptc CO₂,CO₂ partial pressure difference,CO₂ partial pressure deviation degree and lactic acid?Lac?and APACHE ? score of correlation.Comparison between 4 h high lactic acid and low lactic acid group,high APACHE ? group and low APACHE ? arterial blood gas values between a group and the percutaneous numerical difference if there were some correlation she could find.Inclusion criteria: 1.Diagnostic criteria for sepsis-3.0 infectious shock.2.Clinical manifestations of patients with septic shock.3.With the consent of the patient and the family,the informed consent is signed.4.Approved by the ethics committee.Exclusion criteria: 1.The skin on the chest area and the front of the thigh caused extensive damage and infection caused by burns and scald.2.Affected airway ventilation and ventilation function.3.Exclude non-infectious shock patients,such as cardiogenic,hemorrhagic,allergic and neurogenic shock.4.Family members give up further rescue.Results: 1.The correlation between PtcO₂ and PaO₂-PtcO₂ in 4h,24 h,48h patients and PaO₂ was statistically significant?P < 0.05?.There was no correlation between PtcO₂-pa02 /PaO₂ and PaO₂,no statistical significance?P?0.05?.2.Ptc CO₂,Ptc CO₂-pa CO₂ and?Ptc CO₂-pa CO₂?/Pa CO₂ were correlated with Pa CO₂ in 4h,24 h and 48 h,with statistical significance?P?0.05?.3.The correlation between PaO₂,PtcO₂,PaO₂-PtcO₂,Pa CO₂,Ptc CO₂ and Ptc CO₂-Pa CO₂ in 4h patients?P < 0.05?.?PtcO₂-Pa02?/PaO₂,?Ptc CO₂-Pa CO₂?/Pa CO₂ had no correlation with arterial Lac value?P?0.05?.4.4 h patients PaO₂,PtcO₂,PaO₂ PtcO₂,Pa CO₂,Ptc CO₂ Ptc CO₂-Pa CO₂ and APACHE are associated ? score?P?0.05?.?PtcO₂-Pa02?/PaO₂,?Ptc CO₂-Pa CO₂?/Pa CO₂ and APACHE ? score?P?0.05?there is no correlation.5.High lactic acid group and high APACHE ? patients PaO₂,PtcO₂,PaO₂-PtcO₂ significantly lower than the low lactic acid group and APACHE ? group,with statistical significance?P?0.05?,high lactic acid group and high APACHE ? patients Pa CO₂,Ptc CO₂,Ptc CO₂-Pa CO₂ is significantly higher than low lactic acid group and APACHE ? group,there is statistical significance?P?0.05?.6.?PtcO₂-Pa02?/PaO₂,?Ptc CO₂-Pa CO₂?/Pa CO₂ in high and low lactic acid group and high APACHE ? group has no statistically significant difference?P?0.05?.Conclusion: Through the study found that patients with septic shock in adults percutaneous tissue oxygen partial pressure monitoring and arterial blood gas analysis,blood lactic acid,APACHE ? score that there was a correlation between percutaneous tissue oxygen/carbon dioxide monitor,can better reflect high lactic acidosis and APACHE ? score,arterial blood gas in patients with septic shock,microcirculation status and disease severity and prognosis.