乳酸清除率指导脓毒症患者液体复苏效果的临床观察  

Efficacy of fluid resuscitation guided by lactate clearance rate in the patients with sepsis

作　　者：于斌[1] 胡振杰[1] 赵钗[1] 刘丽霞[1] 张勇[1] 朱桂军[1] 王澜涛[1] 李娟[1] 苏丽[1] 

机构地区：[1]河北医科大学第四医院ICU,河北石家庄050011

出　　处：《中国急救医学》2012年第10期903-906,共4页Chinese Journal of Critical Care Medicine

基　　金：河北省卫生厅2012年医学科学研究重点课题计划项目（20120368）

摘　　要：目的观察乳酸清除率指导脓毒症患者液体复苏的效果，为判断液体复苏的终点选择更合理的指标和简便的方法提供理论依据。方法选择河北医科大学第四医院ICU2011-01-2012-01确诊或拟诊的重症脓毒症或脓毒症休克患者40例，年龄33—89岁。所有患者人ICU后给予积极对症处理，并依具体情况尽早开始液体复苏治疗，依次使中心静脉压（CVP）、平均动脉压（MAP）及乳酸清除率和（或）血乳酸浓度达到临界值以完成液体复苏治疗。记录患者入ICU时的一般情况和临床特点，开始液体复苏治疗前后CVP、MAP、乳酸清除率和（或）血乳酸浓度的变化情况以及治疗过程相关情况。结果开始液体复苏治疗后3、6、72h时乳酸清除率分别为（18．23±4．66）％、（41．97±9．85）％、（4S．01±10．21）％。32例患者在6h内达到预先设定的液体复苏治疗目标，余8例患者均在24h内达到预先设定的液体复苏治疗目标。经ICU治疗后31例患者病情好转，9例患者最终死亡。结论乳酸清除率是反映组织灌注和氧代谢的较好指标，在指导脓毒症患者液体复苏治疗方面有重要意义，应予以充分重视。Objective To investigate the efficacy of fluid resuscitation guided by lactate clearance rate in the patients with sepsis, and to provide some theoretical basis for judging the end of fluid resuscitation. Methods Forty patients with severe sepsis or septic shock were admitted to ICU from January 2011 to January 2012 in the Fourth Hospital of Hebei Medical University, aged 33 - 89 years. Patients were eared for according to the prespecified treatment plan. The study protocol was continued until all goals were achieved or for up to 6 hours. The general condition and clinical characteristics when the patients were admitted to ICU, the change of CVP, MAP, lactic acid concentration and （or） the rate of lactic acid clearance before and after the fluid resuscitation treatment, and other related informations in the treatment process were recorded. Results The rate of lactic acid clearance were （18.23 ±4.66）%, （41.97 ±9.85）% and （48.01 ±10.21）% at 3, 6, 72 h after the fluid resuscitation treatment. 32 patients finished the fluid resuscitation treatment within 6 hours, another 8 patients finished the fluid resuscitation treatment within 24 hours. 31 patients improved after the treatment in ICU, 9 patients with multiple organ dysfunction died. Conclusion Lactate clearance rate is a good index of reflecting organization perfusion and oxygen metabolism, and is more significant in guiding fluid resuscitation for patients with sepsis, we should be full attention.

关 键 词：乳酸清除率 脓毒症 液体复苏 

分 类 号：R657.3[医药卫生—外科学]