Title Sustavni prijenos kisika i eliminacija ugljičnoga dioksida u bolesnika sa sepsom : doktorski rad Title (english) Systemic transport of oxygen and elimination of carbon dioxide in patients with sepsis Author Rosana Troskot Perić Mentor Ines Mrakovčić-Šutić (mentor)Mentor Vladimir Pilaš (sumentor)Committee member Ines Mrakovčić-Šutić (predsjednik povjerenstva)Committee member Vladimir Pilaš (član povjerenstva)Granter University of Rijeka Defense date and country 2011-09-07, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Universal decimal classificationUDC ) 616 - Pathology. Clinical medicine Abstract Cilj istraživanja. Ispitati promjene vensko-arterijskoga gradijenta ugljinoga dioksida (V-a
PCO2) u septikih bolesnika i njegovu prognostiku vrijednost na preživljavanje bolesnika s
teškom sepsom i septikim šokom.
Ispitanici i metode. Praeni su bolesnici koji su lijeeni u Jedinici intenzivnoga lijeenja
Klinike za unutrašnje bolesti Ope bolnice Sveti Duh u Zagrebu, tijekom etiriju godina, od
sijenja 2004. do prosinca 2007. godine. U studiju je ukljuen 71 odrastao bolesnik (25 žena i
46 muškaraca) koji je ispunio kriterije za tešku sepsu i septiki šok prema American College
of Chest Physicians i Society of Critical Care Medicine. Ovisno o tome jesu li prije
provedenih mjerenja bili na mehanikoj ventilaciji, bolesnici su podijeljeni u dvije skupine:
skupinu bez respiratora i skupinu s respiratorom. V-a PCO2 izraunat je iz razlike parcijalna
tlaka ugljinoga dioksida arterijske krvi (PaCO2) i miješane venske krvi (PvCO2) koja je
odreivana uporabom plunoga arterijskog (Swan-Ganzova) katetera. Kao vrijednost
razgranienja V-a PCO2 uzeli smo 0.8 kPa. Kaplan-Meierova metoda uporabljena je za
analizu preživljenja, s Breslowim testom, pri emu je trajanje hospitalizacije rabljeno kao
vremenski parametar, a smrtni je ishod uzet kao parametar ishoda.
Rezultati. Pronaene su znaajne razlike u preživljenju meu bolesnicima koji su bili bez
respiratora i koji su bili s respiratorom, s omjerom rizika (hazard ratio) za smrtni ishod
gotovo etiri puta veim u onih koji su bili s respiratorom (3.85; 95% 95% vjerojatnost, 1.64-
9.03). Rezultati ovoga istraživanja pokazuju veliki broj promjena u skupini s respiratorom:
znaajno više vrijednosti PaCO2, PvCO2, V-a PCO2, laktata, indeksa tjelesne mase (ITM),
Simplified Acute Physiology II Score (SAPS II), Acute Physiology and Chronic Health
Evaluation II Score (APACHE II), Sepsis-related Organ Failure Assessment Score (SOFA)
prvoga i treeg dana; dok su vrijednosti pH arterijske (A pH) i venske krvi (V pH), srednjega arterijskog tlaka (MAP) i sustavnoga krvožilnog otpora (SVR) bile znaajno niže u odnosu na
skupinu bez respiratora. Preživljenje u skupini bolesnika bez respiratora i s respiratorom
znaajno se razlikovalo, ovisno o vrijednostima V-a PCO2 (cut-off vrijednosti, 0.8 kPa).
Unutar skupine bolesnika s respiratorom nije pronaena razlika u preživljavanju izmeu onih
bolesnika ija je vrijednost V-a PCO2 bila iznad, tj. ispod 0.8 kPa (P = 0.270), a unutar
skupine bolesnika bez respiratora pokazano je statistiki znaajno bolje preživljavanje
bolesnika u kojih je vrijednost V-a PCO2 manja od 0.8 kPa (P = 0.015).
Zakljuak. U ovom se istraživanju V-a PCO2 pokazao statistiki znaajnim pretkazateljem
smrtnoga ishoda jedino u skupini bolesnika bez respiratora. Bolesnici s respiratorom su bili
hospitalizirani u manje povoljnom statusu pa drugi parametri npr. APACHE II, SOFA, SAPS
II, laktati imaju važnu ulogu u ishodu bolesti u tih bolesnika.
Abstract (english) Objectives To investigate the changes in the venoarterial carbon dioxide gradient (V-a PCO2)
and its prognostic value for survival of patients with severe sepsis and septic shock.
Patients and Methods The study was conducted in General Hospital Holy Spirit from
January 2004 to December 2007 and included 71 conveniently sampled adult patients (25
women and 46 men), who fulfilled the severe sepsis and septic shock criteria and were
followed for a median of 8 days (interquartile range, 12 days). The patients were divided in
two groups depending on whether or not they had been mechanically ventilated. Both groups
of patients underwent interventions with an aim to achieve hemodynamic stability.
Mechanical ventilation was applied in respiratory failure. Venoarterial carbon dioxide
gradient was calculated from the difference between the partial pressure of arterial CO2 and
the partial pressure of mixed venous CO2, which was measured with a pulmonary arterial
Swan-Ganz catheter. The data were analyzed using Kaplan-Meier survival analysis, along
with a calculation of the hazard ratios.
Results There was a significant difference between nonventilated and ventilated patients, with
almost 4-fold greater hazard ratio for lethal outcome in ventilated patients (3.85; 95%
confidence interval, 1.64-9.03). Furthermore, the pattern of changes of many other variables
was also different in these two groups (carbon dioxide-related variables, variables related to
acid-base status, mean arterial pressure, systemic vascular resistance, lactate, body mass
index, Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology II
Score, and Sepsis-related Organ Failure Assessment Score). V-a PCO2 values (with a cut-off
of 0.8 kPa) were a significant predictor of lethal outcome in non-ventilated patients (P =
0.015) but not in ventilated ones (P = 0.270). Conclusion The venoarterial carbon dioxide gradient was a significant predictor of fatal
outcome only in the non-ventilated group of patients. Ventilated patients are more likely to be
admitted with a less favorable clinical status, and other variables seem to have a more
important role in their outcome.
Keywords
prijenos kisika
sustavni
ugljini dioksid
eliminacija
sepsa
hemodinamika
pluni arterijski kateter
Keywords (english)
Oxygen Transport
Systemic
Carbon Dioxyde
Elimination
Sepsis
Hemodynamic Monitoring
Pulmonary Arterial Catheter
Language croatian URN:NBN urn:nbn:hr:188:675511 Study programme Title: Biomedicine Postgraduate (doctoral) study programme Catalog URL https://libraries.uniri.hr/cgi-bin/unilib.cgi?form=D1121018064 Type of resource Text Extent 140 str. File origin Born digital Access conditions Closed access Terms of use Created on 2017-01-19 18:54:30
