早期动脉血乳酸清除率预测心源性休克患者预后的临床研究  

The predictive value of early arterial lactate clearance rate in cardiogenic shock

作　　者：汪华玲[1] 郑瑞强[2] 陈齐红[2] 

机构地区：[1]江苏省苏北人民医院心血管内科,扬州225001 [2]江苏省苏北人民医院重症医学科,扬州225001

出　　处：《中华重症医学电子杂志》2017年第1期50-54,共5页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：国家自然科学基金项目(81670065)

摘　　要：目的探讨心源性休克患者早期动脉血乳酸清除率对预后的预测。方法前瞻性观察性研究2013年2月至2016年3月江苏省苏北人民医院收治的心源性休克患者85例,抽取诊断心源性休克时(0 h)及6 h动脉血检测乳酸水平。根据心源性休克患者28 d转归分为存活组(55例)与死亡组(30例),采用t检验比较2组患者动脉血乳酸及乳酸清除率,通过受试者工作特征(ROC)曲线分析动脉血乳酸及乳酸清除率预测心源性休克患者预后的阈值及其敏感度与特异度等诊断试验评价指标。结果 (1)死亡组0 h动脉血乳酸为(4.18±1.39)mmol/L,明显高于存活组(3.35±1.03)mmol/L,差异有统计学意义(t=2.056,P<0.05)。与存活组(1.98±0.69)mmol/L比较,死亡组6 h动脉血乳酸水平(3.43±1.54)mmol/L增高,差异有统计学意义(t=4.464,P<0.05)。根据心源性休克患者0 h与6 h动脉血乳酸值,计算出6 h乳酸清除率。与存活组(38.7±17.9)%比较,死亡组6 h乳酸清除率(18.8±14.7)%较低,差异有统计学意义(t=21.842,P<0.05)。(2)0 h动脉血乳酸>3.39 mmol/L预测心源性休克患者死亡,阈值为3.39 mmol/L,敏感度为80%,特异度为72%;6 h动脉血乳酸>2.32 mmol/L预测心源性休克患者死亡,阈值为2.32 mmol/L,敏感度为80%,特异度为72%;6 h动脉血乳酸清除率<30.07%预测心源性休克患者死亡,阈值为30.07%,敏感度为68%,特异度为67%。结论早期动脉血乳酸清除率可预测心源性休克患者预后。To explore the predictive value of early arterial lactate and lactate clearance rate in cardiogenic shock. The study prospectively recruited 94 cardiogenic shock patients who admitted to the department of critical care medicine in Subei People′ Hospital from February 2013 to March 2016. The arterial lactate at the moment of diagnosis of （0 h lactate） and 6 h after diagnosis were reviewed. According to the outcome, patients were divided into survival group （n=55） and non-survival group （n=30）. The arterial lactate at 0 h and 6 h and lactate clearance rate in each group were analyzed. The receiver-operating characteristic （ROC） curve was plotted to assess the predictive value of lactate and lactate clearance rate. （1）Arterial lactate at 0 h in survival group （3.35±1.03）mmol/L was significantly lower than in non-survival group （4.18±1.39）mmol/L, the difference was statistically significant （t=2.056, P〈0.05）. Compared with non-survival group （3.43±1.54）mmol/L, arterial lactate at 6 h in survival group were significantly lower （1.98±0.69）mmol/L, the difference was statistically significant （t=4.464, P〈0.05）. （2）The cut-off value of arterial lactate at 0 h and 6 h was 3.39 mmol/L and 2.32 mmol/L, with sensitivity and specificity both being 80% and 72%, respectively. Furth ermore, the cut-off value of arterial lactate clearance rate was 30.07%, with sensitivity and the specificity being 68% and 67%, respectively. Early arterial lactate clearance rate could be an indicator to predict the prognosis in cardiogenic shock patients.

关 键 词：休克 心源性 预后 乳酸清除率 

分 类 号：R541.64[医药卫生—心血管疾病]