心肺复苏后多器官功能障碍患者早期乳酸清除率与预后的相关性  

Clinical analysis of a correlation between lactate clearance and prognosis in patients with multiple organ dysfunction syndrome following resuscitation

作　　者：李洪祥[1] 张东[1] 刘忠民[1] 王育珊[1] 霍霏霏[1] 

机构地区：[1]吉林大学第一医院ICU,长春130021

出　　处：《中华急诊医学杂志》2013年第8期842-845,共4页Chinese Journal of Emergency Medicine

基　　金：基金项目：国家自然科学基金资助项目（30870351）;吉林省科技发展计划项目（200705201）

摘　　要：目的探讨乳酸清除率与心肺复苏后多器官功能障碍综合征患者预后的相关性。方法采用回顾性临床研究方法分析心肺复苏后多器官功能障碍综合征患者，纳入标准为2009年1月至2011年12月期间院前或院内心肺复苏后存活24h以上，收入吉林大学第一医院ICU并发生多器官功能障碍综合征的成年患者；排除各种疾病终末期、外伤所致心脏停搏。分别在自主循环恢复（ROSC）后3d、7d时将患者分为存活组和死亡组，采用秩和检验及逻辑回归方法分别比较两组患者的年龄、性别、平均动脉压、氧合指数、APACHEⅡ评分、白细胞计数、初始乳酸值及6h乳酸清除率之间的差异。结果有42例患者符合标准，在自主循环恢复后3d、7d时分别存活23人（54．8％）和14人（33．3％）。在自主循环恢复后3d、7d时对上述指标进行单因素分析显示，死亡组APACHEⅡ评分均明显高于存活组（P〈0．05），死亡组6h乳酸清除率均明显低于存活组（P〈0．05），其余指标比较差异均无统计学意义（P〉0．05）。进一步多因素Logistic回归分析显示，在自主循环恢复后3d时存活和死亡两组比较，APACHEⅡ评分和6h乳酸清除率差异均无统计学意义（P〉0．05）；而在自主循环恢复后7d时存活和死亡两组比较，APACHEⅡ评分（OR=2．143，P=0．028）和6h乳酸清除率（OR=0．887，P=0．040）均差异具有统计学意义。结论心搏骤停患者自主循环恢复后早期乳酸清除率的降低与不良预后具有一定的相关性，并可能成为心搏骤停患者恢复期死亡的独立预测因子。Objective To assess the relationship between lactate clearance and prognosis of patients with multiple organ dysfunction syndrome following resuscitation. Methods Data of 42 eligible patients with multiple organ dysfunction syndrome after resuscitation admitted from January 2009 to December 2011 were collected for retrospective analysis. The patients included were adult patients who survived more 24 hours after CPR for cardiac arrest with subsequent multi-organ failure. Exclusion criteria were traumatic heart arrest and the end-stage diseases. All the patients were divided into survival group and death group on the 3rd day and the 7th day after restoration of spontaneous circulation. The differences in the age, gender, mean arterial pressure, oxygenation index （PaO2/FiO2 ）, APACHE Ⅱ score, white blood cell count （WBC）, initial lactate level and 6h lactate clearance rate between the two groups were compared by using the Mann-Whitney U-tests and logistic regression analysis. Results Of 42 patients, the mean age was （59.57±14.68） years and mean APACHE Ⅱ score was （26.79±7.77）, and 23 （54.8%） patients survived until the 3rd day and 14 （33.3%） patients survived to the 7th day after restoration of spontaneous circulation （ROSC）. Univariate analysis showed that APACHE Ⅱ score in death group was significantly higher and 6 h lactate clearance was significantly lower than those in survival group （ P 〈 0.05 ） on the 3rd day and the 7th day after ROSC, and other biomarkers were not significantly different between the two groups. The results from logistic regression analysis showed that there were statistically significant difference in APACHEⅡ score （RR=2.143, P =0.028） and 6-h lactate clearance （RR =0.887, P =0.040） between survival group and death group on the 7th day after ROSC, although no significant differences in APACHE Ⅱ score and 6 h lactate clearance were found between the two groups on the 3rd day after ROSC. Conlusions Post-cardiac arrest patients with low lac

关 键 词：心搏骤停 心肺复苏 自主循环恢复 多器官功能障碍综合征 乳酸 乳酸清除 率 预后 预测因子 

分 类 号：R459.7[医药卫生—急诊医学]