外周灌注指数预测手术患者ICU住院时间延长早于且优于乳酸：观察性研究
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Peripheral perfusion index predicting prolonged ICU stay earlier and better than lactate in surgical patients: an observational study
背景与目的
外周灌注指数(PPI)是反映血流灌注的指标。接受长时间手术的患者更容易出现灌注不足和乳酸升高。然而，却很少有研究关注PPI与手术患者预后的关系。为了找出答案，我们进行了这项研究。
方 法
我们回顾了从2019年1月至2019年9月所有转移到某医院ICU的手术患者。纳入标准：年龄≥18岁；手术时间≥120 min。排除标准：死于ICU；违抗医嘱出院；存在影响上肢血流的疾病，如手臂血管血栓；严重肝功能障碍。将ICU住院时间（ICU LOS）超过48 h的患者定义为“ICU滞留时间延长”，并根据定义将患者分为“延长组”(PG)和“非延长组”(NPG)。收集基线特征、手术和治疗信息、ICU LOS、SOFA和APACHE II。记录入科后3个时间点(T0：入ICU时；T1：入ICU后6 h；T2：入ICU 后12 h) 的平均动脉压(MAP)、乳酸、心率(HR)、PPI、体温等数据。对两组数据进行比较。应用逻辑回归模型和ROC曲线分析灌注指标与ICU LOS的关系。
结 果
本研究共纳入168例患者，其中PG组65例，NPG组103例。与NPG组相比，PG组患者的血乳酸水平较高，PPI较低。两组患者间的PPI差异均早于乳酸(T0 vs T1)。PG组两个时间点的PPI值均低于NPG组(T0: 1.09 ± 0.33 vs 1.41 ± 0.45, p = 0.001; T1: 1.08 ± 0.37 vs 1.49 ± 0.41, p < 0.001)。T1时乳酸增加(OR ：3.216；95%CI ：1.253~8.254，P=0.015)和PPI降低(OR：0.070；95%CI :0.016~0.307，P<0.001)是ICU患者住院时间延长的独立相关因素。T1时，PPI 预测ICU住院时间>48 h的ROC下面积为0.772，PPI的临界值为1.35，敏感性为83.3%，特异性为73.8%。
结 论
T1时（入ICU后6h），PPI和血乳酸与手术患者ICU LOS相关。与乳酸相比，PPI能更早地提示灌注不足，更准确地预测患者ICU住院时间延长。
原始文献来源及摘要
Shi X, Xu M, Yu X, et al. Peripheral perfusion index predicting prolonged ICU stay earlier and better than lactate in surgical patients: an observational study.[J] .BMC Anesthesiol, 2020, 20: 153.
Abstract
Background: Peripheral perfusion index (PPI) is an indicator reflecting perfusion. Patients undergoing long time surgeries are more prone to hypoperfusion and increased lactate. Few studies focusing on investigating the association between PPI and surgical patients’ prognoses. We performed this study to find it out.
Methods: From January 2019 to September 2019, we retrospected all surgical patients who were transferred to ICU, Xinyang Central hospital, Henan province, China. Inclusive criteria: age ≥ 18 years old; surgical length ≥ 120 min. Exclusive criteria: died in ICU; discharging against medical advice; existing diseases affecting blood flow of upper limbs, for example, vascular thrombus in arms; severe liver dysfunction. We defined “prolonged ICU stay” as patients with their length of ICU stay longer than 48 h. According to the definition, patients were divided into two groups: “prolonged group” (PG) and “non-prolong group” (nPG). Baseline characteristics, surgical and therapeutic information, ICU LOS, SOFA and APACHE II were collected. Besides we gathered data of following parameters at 3 time points (T0: ICU admission; T1: 6 h after admission; T2: 12 h after admission): mean artery pressure (MAP), lactate, heart rate (HR), PPI and body temperature. Data were compared between the 2 groups. Multivariable binary logistic regression and ROC (receiver operating characteristic) curves were performed to find the association between perfusion indictors and ICU LOS.
Results: Eventually, 168 patients were included, 65 in PG and 103 in nPG. Compared to nPG, patients in PG had higher blood lactate and lower PPI. PPI showed significant difference between two groups earlier than lactate (T0 vs T1). The value of PPI at two time points was lower in PG than nPG(T0: 1.09 ± 0.33 vs 1.41 ± 0.45, p = 0.001; T1: 1.08 ± 0.37 vs 1.49 ± 0.41, p < 0.001). Increased lactateT1(OR 3.216; 95% CI 1.253–8.254, P = 0.015) and decreased PPIT1 (OR 0.070; 95% CI 0.016–0.307,P < 0.001) were independently associated with prolonged ICU stay. The area under ROC of the PPIT1 for predicting ICU stay> 48 h was 0.772, and the cutoff value for PPIT1 was 1.35, with 83.3% sensitivity and 73.8% specificity.
Conclusions: PPI and blood lactate at T1(6 h after ICU admission) are associated with ICU LOS in surgical patient. Compared to lactate, PPI indicates hypoperfusion earlier and more accurate in predicting prolonged ICU stay.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：何幼芹 编辑：冯玉蓉 审校：曹莹