早期乳酸清除率对急性重型颅脑损伤的预后判断价值  

作　　者：杨芳[1] 邓杰[1] 

机构地区：[1]浙江省舟山医院ICU,316000

出　　处：《浙江临床医学》2016年第3期448-450,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨急性重型颅脑损伤患者早期乳酸清除率的临床价值。方法急性重型颅脑损伤患者58例，常规进行格拉斯哥昏迷评分（GCS评分）和急性生理学和慢性健康状况评分系统Ⅱ评分（APACHEⅡ评分），并测定入院时及治疗12h后的血乳酸水平，计算12hSL酸清除率，以12h乳酸清除率10％为界限，分为低乳酸清除率组28例（A组）和高乳酸清除率组30例（B组），对患者进行随访，以患者出现多脏器功能衰竭（MOF）出院或死亡为终点，比较两组间预后的差异，并进行早期乳酸清除率与患者入院时APACHEⅡ评分和GCS评分的相关性分析。同时根据预后分为存活组（43例）和衰竭组（15例），比较两组患者早期乳酸清除率的差异。结果A组MOF发生率高于B组，差异有统计学意义（P〈0．05）；急性重型颅脑损伤患者早期乳酸清除率与APACHEⅡ评分呈负相关（r=0．619，P〈0．05），与GCS评分呈正相关（r=0．538，P〈0．05）；存活组早期乳酸清除率显著高于衰竭组，差异有统计学意义（P〈0．05）。结论早期乳酸清除率可作为评估急性重型颅脑损伤患者病情严重程度和预后转归的指标，结合APACHEⅡ评分和GCS评分进行评估更有价值。Objective To study the clinical value Of early lactate clearance rate in patients with acute severe craniocerebral injury. Methods The Glasgow scale （ GCS scale ） and acute physiology and chronic health evaluation system Ⅱ （ APACHE Ⅱ scale ） were routinely collected in 58 patients with acute severe craniocerebral injury, and the blood lactic acid level on admission to hosipital and after 12 hours of treatment were performed, then the 12h lactate clearance rate was calculated. The patients were assigned into two groups ofA （ the 12h lactate clearance rate〈10%, 28 cases ） and B （ the 12h lactate clearance rate≥ 10%, 30 cases ） .The incidence rate of multiple organ failure （ MOF ） was compared between the two groups. The relationship between the early lactate clearance rate and APACHE Ⅱ scale and GCS scale was investigated. At the same time, according to study endpoint the 58 patients were divided into survival group （ 43 cases ） and failure group （ 15 cases ） , the early lactate clearance rate of the two groups were compared. Results The incidence rate of MOF in group A was higher than that in group B （ P〈0.05 ） .The early lactate clearance rate had a positive correlation with GCS scale （ r=0.538, P〈0.05 ） and a negative correlation with APACHE Ⅱ scale （ r=-0.619, P〈0.05 ） in patients with acute severe craniocerebral injury. The early lactate clearance rate of survival group was significantly higher than failure group, with statistical significance （ P〈0.05 ） . Conclusions Early lactate clearance rate can be used as an indicator for evaluating the severity and prognosis of patients with acute severe craniocerebral injury. Andit was more sensitive and valuable when combining with the APACHE II scale and the GCS scale.

关 键 词：急性重型颅脑损伤 乳酸 乳酸清除率 

分 类 号：R651.15[医药卫生—外科学]