乳酸清除率在脓毒症病情判断及预后评估的应用效果分析  

Effects of lactic acid and lactate clearance rate on sepsis disease judgment and evaluation of prognosis

作　　者：许世琴[1] 贾安奎[2] 徐爱华[1] 范杰斐[1] 李良[1] XU Shi-qin JIA An-kui XU Ai-hua FAN Jie-fei LI Liang(Xinxiang Central Hospital, Xinxiang, Henan 453000, Chin)

机构地区：[1]新乡市中心医院检验科,河南新乡453000 [2]新乡医学院第一附属医院检验科,河南新乡453000

出　　处：《中华医院感染学杂志》2017年第5期996-999,共4页Chinese Journal of Nosocomiology

摘　　要：目的观察和分析乳酸和乳酸清除率在脓毒症病情判断、预后评估方面的效果,以期筛选出有价值的指标协助临床诊疗,降低病死率。方法选取2012年4月-2015年12月198例脓毒症患者,根据入院后动脉血乳酸水平,将纳入的198例脓毒症患者分为低乳酸组99例、中乳酸组65例和高乳酸组34例,参考预后分为生存组154例和死亡组44例,比较不同组别患者乳酸水平、乳酸清除率,血乳酸水平工作ROC曲线、影响预后因素的多元Logistic逐步回归分析及乳酸、乳酸清除率与APACHEⅡ评分的相关性分析。结果低、中乳酸组生存率高于死亡率,差异有统计学意义(P<0.05);低乳酸组生存率高于中、高乳酸组,死亡率低于中、高乳酸组,差异有统计学意义(P<0.05);6h、12h、24h、48h,生存组血乳酸水平低于入院时,差异有统计学意义(P<0.05),死亡组与入院时比较,差异无统计学意义,生存组血乳酸水平低于死亡组,乳酸清除率高于死亡组,差异有统计学意义(P<0.05);乳酸水平、乳酸清除率和APACHEⅡ评分是影响脓毒症患者预后的独立危险因素,乳酸水平与APACHEⅡ评分呈正相关性(P<0.05),乳酸清除率与APACHEⅡ评分呈负相关性(P<0.05)。结论乳酸和乳酸清除率在脓毒症病情判断、预后评估方面意义重大,能有效反映病情程度、指导临床治疗、预测结局,且检测方便、简捷、经济,值得临床推广。OBJECTIVE To observe and analyze the effects of lactic acid and lactic acid clearance rate on sepsis judgment and prognosis evaluation, so as to screen out valuable indicators to help clinical diagnosis and treatment, and reduce mortality. METHODS From Apr. 2012 to Dec. 2015, 198 patients with sepsis were selected. The patients were divided into low lactic acid group （n= 99）, middle lactic acid group （n= 65） and high lactic acid group （n= 34） according to the level of lactic acid after admission, and were divided into survival group （n= 154） and death group （n=44） according to the prognosis. The multivariate logistic regression analysis of lactic acid level, lactic acid clearance rate, blood lactate ROC curve and prognostic factors in different groups were compared and the cor- relations between lactate, lactate clearance and APACHE Ⅱ score were analyzed. RESULTS The survival rates of low and medium lactic acid groups were higher than mortality, and the difference was significant （P〈0.05）. The survival rate of low lactic acid group was higher than that of medium and high lactic acid groups, and the mortality was lower than that of medium and high lactic acid groups （P〈0.05）. The levels of lactic acid in survival group at 6 h, 12 h, 24 h and 48 h were lower than that of admission, the difference was significant （P〈0.05）, and there was no significant difference of death group with admission. The level of lactic acid of survival group was lower than that of death group, the lactic acid clearance rate was higher than that of death group, and the differences were significant （P〈0.05）. Lactic acid level, lactic acid clearance rate and APACHE Ⅱ score were independent risk factors for prognosis of patients with sepsis. Lactic acid level was positively correlated with APACHE Ⅱ score （P〈0. 05）, while lactic acid clearance rate was negatively correlated APACHE Ⅱ score （P〈0. 05）. CONCLUSION Lactic acid and lactic acid clearance rate is significant in sepsis with

关 键 词：脓毒症 乳酸 乳酸清除率 病情 预后 

分 类 号：R631.2[医药卫生—外科学]