关键词: 脓毒症, 腹膜炎, 呼吸商, 乳酸

Abstract: Objective　To investigate the prediction of the ratio of venous-to-arterial carbon dioxide partial pressure difference to arteriovenous oxygen content difference in peritonitis-associated septic shock in children. Methods　The clinical data of 63 cases of peritonitis-associated septic shock treated in the Paediatric Intensive Care Unit of the Childrens Hospital Affiliated to Xian Jiaotong University from December 2016 to December 2021 were collected and analyzed retrospectively. The data were analyzed by SPSS21.0 statistical software. According to different prognosis，the children were divided into survival group and death group.  An independent sample t-test was performed to compare the differences in continuous quantitative variables with normal distribution between the two groups. Categorical variables were compared using a Pearsons Chi-square test. Binary Logistic regression was used to evaluate all variables for prognosis prediction，and the receiver operating characteristic （ROC）curve was used to analyze the predictive value of risk factors. The area under the curve （AUC）being >0.5 was considered as being with predictive value. Results　A total of 63 children were enrolled，including 30 males and 33 females. There were no significant differences in gender，age，weight or pathogen distribution between the two groups. Compared with the survival group，the death group was higher in proportion of ventilation，surgical intervention and vasoactive agents use，procalcitonin，lactate，the ratio of venous-to-arterial carbon dioxide partial pressure difference to arteriovenous oxygen content difference，pediatric sequential organ dysfunction score，activated partial thromboplastin time，and score of the pediatric risk of mortality，but was lower in platelets，fibrinogen and mean arterial pressure All the differences were statistically significant （all P<0.05）. Binary Logistic regression analysis was used to screen the variables and it was found that serum lactate and the ratio of venous-to-arterial carbon dioxide partial pressure difference to arteriovenous oxygen content difference were independent risk factors that might affect prognosis. ROC curve showed that lactate AUC was 0.745 with a sensitivity of 75% and specificity of 71%；AUC of the ratio of venous-to-arterial carbon dioxide partial pressure difference to arteriovenous oxygen content difference was 0.876，with sensitivity being 85% and specificity 87%.The combined AUC was 0.923，sensitivity being 88% and specificity being 91%. Conclusion　The ratio of venous- arterial carbon dioxide partial pressure difference to arterial-venous oxygen content difference has a good predictive value for the prognosis of peritonitis-associated septic shock in children.

Key words: sepsis, peritonitis, respiratory quotient, lactate