血乳酸与APACHE Ⅱ评分对感染性休克患者预后影响的分析  

Analysis on effect of lactate and APACHEⅡscores on the prognosis of the septic shock patients

作　　者：马建齐[1] 白静慧[1] 蒋雷[1] 王志勤[2] 

机构地区：[1]辽宁省肿瘤医院ICU,辽宁沈阳110041 [2]解放军第二军医大学检验科,上海200433

出　　处：《中国医药导报》2013年第31期166-168,共3页China Medical Herald

基　　金：国家自然科学基金资助项目(编号81171844)

摘　　要：【摘要】目的研究感染性休克患者动脉血乳酸浓度与APACHEⅡ评分的关系及其对预后的影响。方法回顾性分析42例感染性休克患者的临床资料，患者在转入辽宁省肿瘤医院ICU时进行APACHEⅡ评分及动脉血血乳酸测定，6h后再次进行血乳酸测定．并计算血乳酸清除率；比较不同APACHEⅡ评分分值组的动脉血乳酸浓度及APACHEⅡ与血乳酸浓度间的相关性：根据患者的预后情况将患者分为死亡组和存活组，观察两组患者血乳酸浓度的变化、APACHEⅡ评分及乳酸清除率情况。结果随着APACHEⅡ评分分值的升高（〈15、15～〈25、25-〈35、≥35分），动脉血乳酸浓度也逐渐升高[（3．45±0．12）、（4．71±1．04）、（9．80±3．29）、（14．29±0．88）mmol／L]，差异均有高度统计学意义（均P〈0．01）；动脉血乳酸浓度与APACHEII评分呈正相关（r=0．962，P〈0．001）；死亡组APACHEⅡ评分分值、血乳酸浓度高于存活组，而乳酸清除率均低于存活组，差异有高度统计学意义（P〈0．001），血乳酸值〉10mmol／L且6h血乳酸清除率〈10％的13例感染性休克患者均死亡。结论随着APACHEⅡ评分的增高。动脉血乳酸浓度逐渐增高，而乳酸清除率逐渐下降，这与病情严重度呈正相关。【关键词】感染性休克；动脉血乳酸；乳酸清除率；APACHEII评分【中图分类号】R441．[Abstract] Objective To study the relationship between in blood lactate concentration and APACHE Ⅱ score, and effect on prognosis of septic shock patients. Methods 40 cases of septic shock patients were collected and analyzed, APACHE II scores and lactate concentration in arterial blood were measured after admitted by ICU department of Liaoning Cancer Hospital, the lactate was measured again after 6 hours and the lactate clearance rate was computed. The lactate concentration of patients with different APACHE Ⅱ scores were compared and the relationship between lactate concentration and APACHE Ⅱ scores was evaluated. Patients were divided into death group and survival group according to the prognosis. Then the lactate level, APACHE Ⅱ scores and the lactate clearance rate of the two groups were compared. Results The lactate concentration of patients gradually rose [（3.45±0.12）, （4.71±1.04）, （9.80±3.29）, （14.29±0.88） mmol/L] with the increase of APACHE Ⅱ scores（〈15, 15-〈25, 25-〈35, ≥ 35分）,the differences were statistically significant （all P 〈 0.05）. There was a positive correlation between lactate concentration and APACHE Ⅱ scores （r = 0.962, P 〈 0.001）. Lactate concentration and APACHE Ⅱ scores of the death group were higher than that in survival group, 13 septic shock patients whose lactate concentration〉 10 mmol/L and the lactate clearance rate 〈 10% in 6 hours were all death. Conclusion The lactate concentration gradually rose with the in crease of APACHE Ⅱ scores, but the lactate clearance rate is decreasing, they are positively correlated with the disease severity. [Key words] Septic shock; Lactate in arterial blood; Lactate clearance rate; APACHE Ⅱ score

关 键 词：感染性休克 动脉血乳酸 乳酸清除率 APACHEII评分 

分 类 号：R441.9[医药卫生—诊断学]