早期乳酸清除率对多发伤患者预后的评估  

The evaluation of early lactate clearance rate in outcome for multiple trauma patients

作　　者：高秋琦[1] 

机构地区：[1]温州医学院附属第一医院,浙江温州325000

出　　处：《现代实用医学》2009年第2期114-116,共3页Modern Practical Medicine

摘　　要：目的探讨早期乳酸清除率对多发伤患者的预后评估价值。方法回顾性分析经积极治疗的57例多发伤患者,收集治疗前、后6h的中心静脉全血乳酸浓度,计算6h乳酸清除率,并与24hAPACHEⅡ评分作相关性比较。结果(1)将乳酸清除率以50%和25%为界分为三组,三组患者病死率和多脏器功能不全(MODS)发生率比较,差异有显著统计学意义(04%33.33%和8.70%40%66.67%,<0.01)。(2)预后不同的三组患者治疗前、后6h的中心静脉全血乳酸浓度、6h乳酸清除率和24hAPACHEⅡ评分比较:好转组:MODS:死亡组分别为4.82±2.94mmol/L6.08±2.29mmol/L9.18±1.79mmol/L;2.19±1.40mmol/L4.24±1.82mmol/L9.00±2.20mmol/L;54.98%±4.13%31.29%±8.48%7.08%±12.33%;13.63±2.3516.78±3.0023.50±1.29,差异有显著统计学意义(<0.01)。(3)多发伤患者6h乳酸清除率与24hAPACHEⅡ评分有较高的相关性(=―0.709,<0.01)。结论早期乳酸清除率是判断多发伤患者预后的一个较好指标。Objective To study the evaluation of early lactate clearance rate in outcome of multiple trauma patients. Methods Fifty-seven multiple trauma patients were selected. Central vein lactate were measured before and six hours after early treatment, and lactate clearance rate was calcuated, which was compared with twenty-four- hour APACHE- Ⅱ score. Results （1） When the lactate clearance rate was divided into groups by 50% and 25%, the mortality and mobidity of multiple organ dysfunction syndrome（MODS） in different lactate clearance rate group showed statistical differences （0 vs 4% vs 33.33% and 8.70% vs 40% vs 66.67%, P〈0.01）. （2） Central vein lactate before and six hours after early treatment and lactate clearance and twenty-four-hour APACHE- Ⅱ score in different outcome group were compared, and upturn vs MODS vs death was 4.82±2.94 mmol/L vs 6.08±2.29 mmol/L vs 9.18±1.79mmol/L;2.19± 1.40mmol/L vs 4.24±1.82mmol/L vs 9.00±2.20 mmol/L;54.98%±4.13% vs 31.29%±8.48% vs 7.08%±12.33%; 13.63±2.35 vs 16.78±3.00 vs 23.50±1.29, all showing statistical differences （P〈0.01）. （3） There was an obvious correlation between six-hour lactate clearance rate and twenty-four-hour APACHE Ⅱ score in multiple trauma patients （r=-0.709, P〈0.01）. Conclusion Early lactate clearance rate can be regarded as a good indicator of outcome to multiple trauma patients.

关 键 词：乳酸 代谢 多处创伤 预后 

分 类 号：R631[医药卫生—外科学]