血乳酸水平和SOFA评分对急诊严重脓毒症患者的评估作用  

Roles of blood lactate level and SOFA score in the assessment of emergency patients with severe sepsis

作　　者：李晓晶[1] 陈旭岩[1] 

机构地区：[1]北京大学第一医院急诊科,北京100039

出　　处：《中国急救医学》2013年第3期196-199,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨SOFA评分和动脉血乳酸在急诊严重脓毒症患者中的变化及其与预后的关系。方法检测我院急诊重症观察室中的28例严重脓毒症患者入院时和正规治疗6h的动脉血气分析、血常规、血肝。肾功能，监测入院时和正规治疗6h后平均动脉压、心率、体温和尿量变化。比较两组SOFA评分、血乳酸和6h乳酸清除率。结果治疗前血乳酸水平死亡组（7．98±4．24）mmol/L明显高于存活组（3．99±4．09）mmol/L，差异有统计学意义（P〈0．05）。治疗前死亡组SOFA评分（7．55±2．67）分明显高于存活组（4．94±3．49）分，差异有统计学意义（P〈0．05）。应用治疗前SOFA评分判断严重脓毒症患者预后的ROC曲线下面积（AUC）是0．798，治疗前血乳酸的AUC是0．847。结论严重脓毒症患者的初始血乳酸水平和SOFA评分越高，患者预后越差。早期监测患者血乳酸水平，进行SOFA评分是急诊判断严重脓毒症患者病情严重程度和预后的良好方法。Objective To observe the changes of the SOFA score and arterial blood lactate in the patients with severe sepsis, and to discuss the clinical significance in the prognosis. Methods Patients were divided into the dead group and the survival group. 28 severe sepsis patients were collected for lactic acid examination. Arterial blood gas analysis, liver and renal function, the average arterial pressure, heart rate, body temperature and urine volume changes in two groups were observed, SOFA score was calculated at admission and after the treatment. SOFA score, arterial blood lactate and lactate clearance rate were compared in two groups. Results At admission, the blood lactate level was significantly higher in the dead group （7.98 ±4.24） mmol/L than in the survival group （3.99 ±4.09） mmol/L （P 〈 0. 05 ） ; SOFA scorewas obviously higher in the dead group （ 7.55 ± 2.67 ） than in the survival group （4.94± 3.49） （ P 〈 0.05 ） ; the area under the curve （AUC） of SOFA score was 0. 798, the AUC of blood lactate was O. 847. Conclusion The higher initial blood lactate levels and SOFA score the patients have, the worse the prognosis is. Early monitoring of blood lactate levels and the SOFA score are a good method for evaluating the severity of the disease and the prognosis in severe septic patients in the emergency room.

关 键 词：动脉血乳酸 感染相关器官衰竭估计(SOFA)评分 严重脓毒症 乳酸清除率 

分 类 号：R59[医药卫生—内科学]