血乳酸水平和乳酸清除率对感染性休克患者预后的评估  

Evaluation of lactic acid level in blood and its clearance rate in the prognosis of patients with infectious shock

作　　者：杨芳[1] 闫芳[1] 

机构地区：[1]四川省成都市第五人民医院重症医学科,四川成都611130

出　　处：《实用临床医药杂志》2014年第16期44-46,共3页Journal of Clinical Medicine in Practice

基　　金：中国高校医学期刊临床专项资金(11321581)

摘　　要：目的探讨血乳酸水和乳酸清除率对感染性休克患者预后的评估价值。方法回顾性分析2011年5月-2013年10月的88例感染性休克患者的临床资料,按住院28 d是否存活为标准将88例患者分为存活组(48例)和死亡组(40例)。观察2组患者的6 h及24 h血乳酸水平、乳酸清除率和急性生理与慢性健康评分Ⅱ(APACHEⅡ)差异,不同6 h乳酸清除率患者的存活率差异,以及血乳酸水平、乳酸清除率与预后的相互关系。结果 2组初始乳酸水平无显著差异(P>0.05);存活组的6h和24h血乳酸水平、APACHEⅡ评分均显著低于死亡组(P<0.01);6h及24h乳酸清除率均显著高于死亡组(P<0.01);6 h乳酸清除率≥10%的患者存活率91.49%,显著高于乳酸清除率<10%的患者存活率12.20%(P<0.01);多元回归分析发现,6 h及24 h乳酸清除率是患者死亡的独立影响因素(P<0.01)。结论感染性休克患者动态监测血乳酸水平具有重要意义,6 h及24 h乳酸清除率可作为评估患者预后的指标。Objective To discuss the evaluation value of blood lactic acid level and its clearance rate in the prognosis of patients with infectious shock. Methods The clinical data of 88 patients with infectious shock in our hospital from May 2011 to October 2013 were retrospectively analyzed and divided into survival group（48 cases） and death group（40 cases） according to whether the patients were alive or dead after 28 d of hospitalization. The blood lactic acid level,clearance rate of lactic acid as well as Acute Physical and Chronic Health Evaluation Ⅱ（APACHEⅡ） at 6 and 24 h after hospitalization,the survival rate of patients with different clearance rates of lactic acid after 6 h,and the relationship between blood lactic acid level and its clearance rate with the prognosis were observed.Results There was no significant differences between two groups in the initial level of lactic acid（P〉0. 05）. Survival group was apparently lower in blood lactic acid levels at 6 and 24 h（P〈0. 01）and obviously higher in their clearance rates than death group（P〈0. 01）. The survival rates of patients with clearance rate ≥10% in 6 h was 91. 49%,evidently higher than that of in patients（12.20%） with 6 h clearance rate 10%（P〈0. 01）. Multiple linear regression analysis showed that the clearance rate of lactic acid at 6 and 24 h were the independent influencing factors of patients＇ death（P〈0. 01）. Conclusion Dynamic detection of blood lactic acid has critical significance in patients with infectious shock,and the clearance rates of lactic acid at 6 and 24 h can be regarded as the main indexes in evaluating patients＇ prognosis.

关 键 词：感染性休克 血乳酸水平 乳酸清除率 急性生理与慢性健康Ⅱ评分 早期目标导向性治疗 预后 

分 类 号：R631[医药卫生—外科学]