早期乳酸清除率指导创伤失血性休克患者液体复苏的临床价值  

Clinical significance of early lactate clearance rate as an indicator during volume therapy in patients with traumatic hemorrhagic shock

作　　者：张家留[1] 高伟[1] 殷丽萍[1] 周丹丹[1] 张蓓蓓[1] 陈浩[1] 张丰[1] 张爱萍[1] 

机构地区：[1]江苏省中西医结合医院重症医学科,210028

出　　处：《江苏医药》2014年第19期2310-2311,共2页Jiangsu Medical Journal

基　　金：中国中医科学院江苏分院青年课题(JSBY1307)

摘　　要：目的评估以早期乳酸清除率(LCR)指导创伤失血性休克患者液体复苏的临床价值。方法失血性休克患者48例随机分为两组:B组25例,按常规复苏指标处理;A组23例,加用6h内LCR>10%为达标。比较两组入ICU时及6h的APACHEⅡ评分、MAP、动脉血乳酸(Lac)和血红蛋白(Hb)水平,计算6h复苏液体总量及患者7d病死率。结果复苏6h后,A组Lac水平低于B组[(4.6±1.4)mmol/L vs.(7.1±1.3)mmol/L],复苏液体总量多于B组[(4.6±2.3)L vs.(3.6±2.7)L],Hb低于B组[(100.7±20.6)g/L vs.(102.4±19.2)g/L](P<0.05)。两组复苏后MAP相仿[(72.3±12.6)mm Hg vs.(70.8±14.3)mm Hg](P>0.05);A组患者7d病死率低于B组(13.0%vs.36.0%)(P<0.05)。结论以早期LCR>10%作为创伤失血性休克患者液体复苏目标之一有一定的临床价值。Objective TO evaluate the role of early lactate clearance rate（LCR） as one of the indicators during volume therapy in the patients with traumatic hemorrhagic shock. Methods Forty- eight patients with traumatic hemorrhagic shock were randomly divided into two groups of B（taking conventional indicators as the goal of therapy, 25 cases） and A （ taking LCR〈 10 % as an additional indicator,23 cases）. Blood lactate （Lac）, hemoglobin （Hb）, mean arterial pressure （MAP） and APACHE 1]. score were measured on admission and 6 hours after therapy. Total amount of fluid infusion and 7-day mortality were calculated. Results Compared with group B after treatment, Lac was significantly lower in group A[（4. 6 ± 1.4） mmol/L vs. （7.1± 1.3） mmol/L] （P〈0. 05）, the amount of infusion was significantly morel（4. 56±2. 32） L vs. （3. 58±2. 65） L] （P〈0. 05）,and Hb was lower[（100. 7±20. 6） g/L vs. （102.4±19.2） g/L] （P〈0. 05）. MAP of group A was similar to that of group B[ （72.3±12.6） mm Hg vs. （70.8 ± 14. 3） mm Hg] （P〉0. 05）. The 7-day mortality was lower in group A than that in group B（13.0% vs. 36.0%）（P〈0. 05）. Conclusion Taking LCR 〉10% as one of the indicators during volume therapy has a certain value in the patients with traumatic hemorrhagic shock.

关 键 词：失血性休克 乳酸清除率 

分 类 号：R459[医药卫生—治疗学]