动脉血乳酸及早期乳酸清除率对COPD合并呼吸衰竭患者预后的评估价值  

Value of arterial blood lactate and early lactate clearance in evaluating the prognosis in patients with COPD merged with respiratory failure

作　　者：何敏[1] 周浴[1] 朱建勇[1] 邝军[1] 张立波[1] 叶青[1] 

机构地区：[1]湖北医药学院附属人民医院呼吸内科一病区,湖北十堰442000

出　　处：《海南医学院学报》2017年第2期169-171,共3页Journal of Hainan Medical University

基　　金：湖北医药学院科技项目(WJ2015MB220)~~

摘　　要：目的:探讨动脉血乳酸及早期乳酸清除率对COPD合并呼吸衰竭患者预后的评估价值。方法:选取COPD并呼吸衰竭患者78例,检测治疗前1d及治疗后6h动脉血乳酸水平,计算早期乳酸清除率;根据入院血乳酸水平将患者分为重度升高组、轻度升高组和正常对照组,比较3组APACHEⅡ评分、28d死亡率等临床相关指标。根据早期乳酸清除率,将患者分为高乳酸清除率组和低乳酸清除率组,比较2组治疗前后动脉血乳酸水平、APACHEⅡ评分、死亡率及动脉血气指标;对COPD并呼吸衰竭进行预后多因素分析。结果:随着治疗前患者血乳酸浓度的升高,其APACHEⅡ评分、机械通气时间、通气率及住院时间、死亡率均呈升高趋势,且3组间差异有统计学意义(P<0.05);与治疗前比较,高乳酸清除率组的动脉血乳酸水平、APACHEⅡ评分及PaCO2均有所下降,PaO2及pH升高(P<0.05),低乳酸清除率组仅PaO2较治疗前升高,高乳酸清除率组死亡率明显低于低乳酸清除率组(P<0.05);早期乳酸清除率是COPD合并呼吸衰竭患者预后保护因素(P<0.05)。结论:COPD合并呼吸衰竭患者的动脉血乳酸水平与早期乳酸清除率均影响患者预后,动态监测早期血乳酸水平的变化,可更好地评估病情严重程度和预后。Objective：To explore the value of arterial blood lactate and early lactate clearance in evaluating the prognosis in patients with COPD merged with respiratory failure.Methods：A total of 78 patients with COPD merged with respiratory failure were included in the study.The arterial blood lactate level 1d before treatment and 6h after treatment was detected.The early lactate clearance was evaluated.The patients were divided into the severe elevation group,mild elevation group,and normal control group according to the blood lactate level.APACHE Ⅱscore,28 d death rate,and other clinical related indicators in the three groups were compared.According to the early lactate clearance,the patients were divided into the high lactate clearance group and low lactate clearance group.The arterial blood lactate level,APACHE Ⅱ score,death rate,and arterial blood gas indicators in the two groups were compared.The multiple-factor analysis of prognosis was performed.Results：With the increasing of blood lactate concentration before treatment,APACHE Ⅱ score,mechanical ventilation time,ventilation rate,hospitalization time,and death rate were gradually elevated,and the comparison among the three groups was statistically significant（P〈0.05）.When compared with that before treatment,the arterial blood lactate level,APACHE Ⅱ score,and PaCO_2 in the high lactate clearance group were significantly reduced,but PaO_2 and pH were significantly elevated（P〈0.05）,while PaO_2 in the low lactate clearance group was significantly elevated（P〈0.05）.The death rate in the high lactate clearance group was significantly lower than that in the low lactate clearance group（P〈0.05）.The early lactate clearance was a factor in protecting the prognosis in patients with COPD merged with respiratory failure（P〈0.05）.Conclusions：The arterial blood lactate level and early lactate clearance can affect the prognosis in patients with COPD merged with respiratory failure.Dynamic monitoring of early blood lactate level can better

关 键 词：慢性阻塞性肺疾病 呼吸衰竭 动脉血乳酸 乳酸清除率 预后 

分 类 号：R563.9[医药卫生—呼吸系统]