感染性休克患者复苏24h内乳酸清除率对预后的评估价值  

Prognostic value of lactate clearance rate during the first 24 hours of resuscitation in septic shock patients

作　　者：张碧波 顾晓蕾 邵杰 龚菊 庾胜 李斌[1] 单巍 

机构地区：[1]扬州大学第五临床医学院常熟市第二人民医院重症医学科,江苏常熟215500

出　　处：《中华医院感染学杂志》2016年第19期4416-4418,共3页Chinese Journal of Nosocomiology

基　　金：常熟市卫计委指导性基金资助项目(csws201414)

摘　　要：目的研究感染性休克患者复苏24h内乳酸清除率对预后的评估价值,以更好的指导液体复苏治疗。方法对2014年6月-2015年6月入住医院ICU治疗34例感染性休克患者进行前瞻性研究,记录复苏开始时及6、24h的乳酸值,并计算乳酸清除率,根据患者28天病死率分为死亡组10例和存活组24例,比较组间复苏6、24h乳酸值及乳酸清除率、APACHEⅡ评分、机械通气时间等指标的差异,通过ROC曲线分析乳酸清除率对预后的评估价值。结果两组患者的初始乳酸值、6h乳酸清除率、机械通气时间等指标差异无统计学意义;复苏6、24h乳酸值及24h乳酸清除率死亡组为(6.79±4.39)(6.13±3.75)mmol/L及(22.10±34.73)%,存活组为(3.27±2.69)(2.33±2.44)mmol/L及(50.74±20.25)%,两组比较差异有统计学意义(P<0.05);6、24h乳酸清除率对预后评估的ROC曲线的曲线下面积(AUC)分别为0.65、0.76。结论液体复苏24h内乳酸清除率与预后密切相关,即使在黄金6h以后,如果乳酸清除率不达标,仍应继续复苏治疗。OBJECTIVE To investigate the prognostic value of lactate clearance rate during the first 24hours（H24）of resuscitation in septic shock patients,in order to better guide the treatment of fluid resuscitation.METHODS Prospective study on 34 patients with septic shock hospitalized in the ICU from Jun.2014 to Jun.2015 were implemented.The lactate concentration was measured at resuscitation began（H0）and at H6,H24 after resuscitation,and the lactate clearance rate was calculated.According to the mortality rate in 28 days,all the patients were divided into death group and survival group.There were 10 patients in death group and 24 patients in survival group.The lactate concentration,lactate clearance rate,APACHEⅡ score and duration of mechanical ventilation of patients were compared at H6 and H24after resuscitation.Prognostic value of lactate clearance rate was analyzed by receiver operating characteristic（ROC）curve.RESULTS There was no significant difference in the initial lactate,lactate clearance rate of H6 and the duration of mechanical ventilation between two groups.The lactate concentration of H6 and H24after resuscitation and H24 lactate clearance rate in death group were（6.79±4.39）（6.13±3.75）mmol/L and（22.10±34.73）%,they were rsspectively（3.27±2.69）（2.33±2.44）mmol/L and（50.74±20.25）%,in the survival group（P〈0.05）.The area under the curve（AUC）of ROC curve for H6 and H24lactate clearance rates were 0.65 and 0.76 respectively.CONCLUSION During the first H24 in the ICU,lactate clearance rate at H24 after resuscitation is closely associated with prognosis.If lactate clearance rate does not reach the standard,resuscitation therapy should be kept using,even after the golden H6.

关 键 词：感染性休克 乳酸 乳酸清除率 预后 

分 类 号：R631.4[医药卫生—外科学]