早期动脉血乳酸评估重症患者病情严重程度及预后的临床研究  

Early arterial blood lactates for evaluating development and prognosis in critically ill patients

作　　者：马春霞[1] 曹相原[2] 

机构地区：[1]宁夏医科大学,宁夏银川750004 [2]宁夏医科大学附属医院,宁夏银川750004

出　　处：《宁夏医学杂志》2010年第10期894-896,共3页Ningxia Medical Journal

摘　　要：目的探讨早期动脉血乳酸(ABL)水平对危重病患者病情严重程度及预后评估的价值。方法将140例重症患者按照ABL三分位数法分为3组:A组,ABL≤1.5mmol/l(n=35);B组,ABL 1.6-4.4mmol/l(n=71);C组,ABL≥4.5mmol/l(n=34)。记录所有患者入ICU 0.5-2h内的ABL值及APACHE II评分。结果①A-PACHE II评分:B组(14.99±7.90)分高于A组(10.77±6.63)分,C组(22.44±10.06)分高于B组(P<0.05)。②C组患者MODS及休克发生率显著高于A、B组(P<0.01);ICU死亡率:B组高于A组,C组高于A、B组(P<0.01);28d生存率:B组低于A组,C组低于A、B组(P<0.01)。③早期ABL水平及APACHE II评分与危重病患者死亡率呈较好的相关关系,ROC曲线下的面积分别为0.825、0.901,95%可信区间分别为(0.852,0.905)、(0.755,0.896)(P=0.000)。④B组的生存天数显著低于A组,C组生存天数显著低于B组(P<0.01)。结论早期ABL水平能有效地评估重症患者病情严重程度及预测预后,是危重病患者重要的床旁监测指标,对危重病的治疗有重要的指导作用。Objective To investigate the value of early arterial blood lactate in evaluating development and prognosis in critically ill patients.Methods According to early arterial blood lactate level after admission ICU within 30 minutes,140 critical patients were divided into three groups： group A was ABL≤1.5mmol/l;group B was ABL 1.6-4.4mmol/l;group C was ABL≥4.5mmol/l.Results The APACHE Ⅱ score of group B（14.99±7.90） was significantly higher than that of group A（10.77±6.63）,and that of Group C（22.44±10.06） was significantly higher than that in group B（P〈 0.05）;The incidence rates of MODS and shock in group C was significantly higher than those of group A and group B（P〈0.01）.The mortality rate of group B in ICU was higher than group A,and that in group C was higher than that of group B（P〈0.01）.The survival rate in 28-day of group B was lower than that of group A,and that of group C was lower than that of group B（P〈0.01）;Early ABL level and APACHE Ⅱ scores exhibited a good correlation with mortality rate.The ROC under curve was 0.825 and 0.901 respectively.The 95 % CI were respectively（0.852,0.905） and（0.755,0.896）（P=0.000）;Existent days in group B was significantly lower that in group A.That in group C was significantly lower that of group B（P〈0.01）.Conclusion Early ABL level may efficiently evaluate degree and prognosis of critically ill,and may direct treatment for a reliable index.

关 键 词：动脉血乳酸 APACHE II评分 危重病 预后 

分 类 号：R446.1[医药卫生—诊断学]