早期乳酸清除率对体外膜氧合治疗后呼吸衰竭患者预后的意义  

Prognostic significance of early lactate clearance rate for severe acute respiratory failure patients on extracorporeal membrane oxygenation

作　　者：臧芝栋[1] 许红阳[1] 董亮[1] 高飞[1] 严洁[1] 

机构地区：[1]南京医科大学附属无锡市人民医院重症医学科,214023

出　　处：《中华结核和呼吸杂志》2014年第3期197-201,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨早期乳酸清除率对体外膜氧合（ECMO）治疗后的重症急性呼吸衰竭患者预后的评估作用。方法选取2007年1月至2013年1月南京医科大学附属无锡市人民医院ICU收治的因重症急性呼吸衰竭而接受静脉-静脉（v—v）ECMO治疗的患者共43例。分别在治疗前0h和治疗后6h测定动脉血乳酸，计算早期（6h）乳酸清除率，并在治疗当天进行APACHEⅡ评分。以治疗后90d为研究终点，将患者分为存活组（24例）和病死组（19例），比较两组患者治疗前动脉血乳酸值、早期乳酸清除率及APACHEⅡ评分。采用受试者工作特征（ROC）曲线分析0h动脉血乳酸、早期乳酸清除率及APACHEII评分对患者预后的评估价值。运用Kaplan-Meier法绘制患者的生存曲线，Log—rank法分析患者生存情况。多因素Logistic回归分析影响患者预后的危险因素。结果（1）存活组0h动脉血乳酸[（3．8±2．1）mmol／L]和APACHEII评分（18±7）低于病死组[分别为（5．9±2．3）mmol／L和（25±7），t值分别为7．924和8．446，均P〈0．05]，但早期乳酸清除率高于病死组[分别为（35．7±20．4）％和（10．7±18．2）％，t=8．607，P〈0．05]。（2）0h动脉血乳酸、早期乳酸清除率及APACHEII评分预测患者90d死亡的ROC曲线下面积分别为0．699±0．083（95％CI为0．567～0．892，P〈0．05）、0．871±0．119（95％CI为0．724～0．980。P〈0．05）和0．836±0．063（95％CI为0．713～0．958，P〈0．05）。以早期乳酸清除率≥17，5％作为评估预后的最佳界值点，敏感度和特异度分别为87．5％和84．2％。（3）Kaplan—Meier生存曲线分析结果显示，高乳酸清除率患者（≥17．5％）和低乳酸清除率患者（〈17．5％）90d生存率分别为78．3％0和30％（x。=10．103，P〈0．05）。（4）多因素Logistic回归分析显示0h血乳酸（OR=1．318，95％CI为1．159—6．882，P〈0．05）、6h乳酸�Objective To investigate the prognostic significance of early lactate clearance rate for severe acute respiratory failure patients on extracorporeal membrane oxygenation（ECMO）. Methods Forty- three patients with severe acute respiratory failure supported by venous-venous （v-v） ECMO were enrolled from January 2007 to January 2013. Arterial blood lactate at pre-ECMO support（O h） and at post-ECMO 6 hours （6 h） were measured and then 6 h lactate clearance rate was calculated. The acute physiology and chronic health evaluation II （ APACHE II ） score was evaluated on the first day of ECMO support. Survival at 90 d after admission was the study endpoint. Patients were divided into the survival group （n = 24 ） hnd the death group （ n = 19 ）. The 0 h blood lactate, 6 h lactate clearance rate and APACHE II score were compared between groups. The value of 0 h blood lactate, 6 h lactate clearance rate and APACHE II score for predicting death was evaluated by receiver operating characteristic （ ROC ） curves. The surviving curve was drawn using the Kaplan-Meier method, and the survival of the patients was analyzed by the Log-rank test. Factors influencing the prognosis were analyzed by the multiple logistic regression analysis. Results （ 1 ） The 0 h blood lactate and APACHE l] score were lower in survivors than in nonsurvivors [ （3.8 ±2. 1 ） mmol/Lvs.（5.9 ±2.3）mmol/L, （18±7） vs. （25 ±7）, t =7.924, 8.446, respectively, both P〈 0. 05 ] , while the 6 h lactate clearance rate was higher in survivors than in nonsurvivors [ （ 35.7 ±20. 4） % vs. （ 10. 7±18.2） % , t = 8. 607, P 〈 0. 05 ]. （2） The areas under the ROC curve of 0 h blood lactate, 6 h lactate clearance rate and APACHE II score for predicting death were 0. 699 ± 0. 083 （95% CI： O. 567 ± 0.892, P〈0.05）, 0.871 ±0.119（95%CI：0.724-0.980, P〈0.05） and 0.836 ±0.063（95%CI： O. 713 -0. 958, P 〈0.05）. The best cutoff point was 17.5% for 6 h lactate clearance with a sensitivity of 87.

关 键 词：代谢清除率 体外膜氧合作用 呼吸功能不全 预后 

分 类 号：R563.8[医药卫生—呼吸系统]