血乳酸在重症感染患者预后中的影响研究  

The significance of blood lactic acid in the prognosis of patients with severe infections

作　　者：韩利红[1] 马原[1] 郑有光[1] 

机构地区：[1]郑州大学附属洛阳中心医院呼吸内科,河南洛阳471009

出　　处：《中华医院感染学杂志》2015年第13期2996-2998,共3页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关基金资助项目(201004023)

摘　　要：目的：探讨血乳酸在重症感染患者预后中的意义，以期为重症感染的诊断、治疗及预后提供科学参考依据。方法选取2013年1－12月收治的脓毒症及感染性休克患者68例为研究对象，入院时进行急性生理和慢性健康状态（APACHEⅡ）评分、血气分析、肝功能、肾功能、电解质等检测，检测入院开始时、入院后6、12、24、48 h血乳酸值，判定治疗后28 d内患者预后。结果28 d内患者死亡29例、存活39例，病死率及存活率分别为42．65％、57．35％，机械通气率、APACHE Ⅱ评分存活组分别为38．24％、（21．38±2．57）分，明显低于死亡组93．10％、（28．94±6．73）分（ P＜0．05）；存活组患者0、6、12、24、48 h时血乳酸值明显低于死亡组，差异有统计学意义（P＜0．05）；入院时检测血乳酸值＞2．5 mmol（高乳酸血症）患者病死率为85．71％，明显高于≤2．5 mmol者病死率的50．00％（ P＜0．05）；12 h时乳酸清除率0时的患者病死率为100．00％、＜10．00％时为71．43％、10．00％～30．00％时为63．64％、≥30．00％时为43．48％（ P＜0．05）。结论动态监测血乳酸值的水平变化能有助于判断重症感染患者预后，早期血乳酸水平越高、12 h乳酸清除率越低则患者越容易出现不良预后。OBJECTIVE To explore the significance of blood lactic acid in the prognosis of patients with severe infec‐tion ,in order to provide scientific reference for diagnosis ,treatment and prognosis of severe infections .METHODS Totally 68 patients with uremia and septic shock admitted during the period of Jan .‐Dec .2013 were selected as the research subjects .Acute physiology and chronic health condition （APACHE Ⅱ ） score ,blood gas analysis , liver function ,renal function ,and electrolyte were tested at admission ,the level of blood lactic acid was detected at admission （0 h） ,6 h ,12 h ,24 h ,and 48 h after admission to determine the prognosis of patients within 28 d after treatment .RESULTS Within 28 d ,29 cases were dead and 39 cases survived ,the mortality and survival rates were 42 .65% ,57 .35% respectively .Mechanical ventilation rate and APACHE Ⅱ score in the survival group was 38 .24% and （21 .38 ± 2 .57） points ,significantly lower than 93 .10% and （28 .94 ± 6 .73） points in the death group （P 2 .5 mmol （high lactic acidosis） at admission was 85 .71% ,significantly higher than the 50 .00% in those with the blood lactic acid level ≤2 .5 mmol （P〈0 .05） .The mortality rate for patients with 12 h lactate clearance rate of 0 was 100 .00% ,71 .43% in those 〈10 .00% ,63 .64% in those 10 .00% ~30 .00% ,43 .48% in those ≥30 .00%（P〈0 .05） .CONCLUSION Dynamic monitoring of changes in the levels of blood lactic acid can help to judge the prognosis of patients with severe infections .Poor prognosis is likely to occur in patients with higher blood lactic acid level in early stage and lower 12 h lactic clearance rate .

关 键 词：重症感染 血乳酸 脓毒症/感染性休克 预后 

分 类 号：R181.32[医药卫生—流行病学]