乳酸联合APACHEⅡ评分系统对老年社区获得性肺炎患者预后的评估价值  

Ability of lactate associated with APACHEⅡscore to predict prognosis of senile patients with community-acquired pneumonia

作　　者：刘思齐[1] 王琦[1] 向华 LIU Siqi;WANG Qi;XIANG Hua(Department of Emergency, Air Force General Hospital, Beijing 100142, China)

机构地区：[1]空军总医院急诊部,北京100142 [2]空军第一后勤训练基地卫生勤务教研室,上海201102

出　　处：《空军医学杂志》2018年第2期138-141,共4页Medical Journal of Air Force

摘　　要：目的研究乳酸(lactic acid,LAC)联合急性生理学与慢性健康状况评分(acute physiology and chronic health evaluation,APACHEⅡ)对老年社区获得性肺炎(community-acquired pneumonia,CAP)患者预后评估的价值。方法选取空军总医院2016年急诊入院的98例老年CAP患者,根据28 d是否存活分为死亡组和存活组,回顾性研究比较死亡组和存活组患者的乳酸值和APACHEⅡ评分。探讨乳酸和APACHEⅡ评分对评估老年CAP患者预后的评估价值。结果死亡组的动脉血乳酸和APACHEⅡ评分明显高于存活组。乳酸与APACHEⅡ评分呈正相关性,随着乳酸的升高,APACHEⅡ评分也相应升高。受试者工作特征曲线(ROC曲线)显示,乳酸、APACHEⅡ评分、乳酸联合APACHEⅡ评分预测老年CAP患者28 d死亡的曲线下面积(AUC)分别是0.796、0.746、0.809,提示,乳酸与APACHEⅡ均可预测死亡率,乳酸值的预测效率相对较高,联合乳酸和APACHEⅡ评分系统的预测效率高于单独的乳酸值和APACHEⅡ评分。结论乳酸和APACHEⅡ均可作为老年社区获得性肺炎患者28 d死亡的独立预测因素,2项指标联合使用的评估价值优于单独使用。Objective To study the ability of lactate associated with APACHEⅡ score to predict the prognosis of senile patients with community-acquired pneumonia. Methods Ninety-eight emergency admitted patients with community-acquired pneumonia above 60 years of age were picked from our hospital throughout 2016. These patients were divided into the death group and survival group according to survival status on day 28. The blood lactate and APACHEⅡscores of both groups were retrospectively studied. The ability of lactate combined with APACHEⅡ to predict the prognosis of senile patients with CAP was evaluated. Results Levels of lactate of the death group were significantly higher than those of the survival group. Lactate and APACHEⅡ scores were positively correlated. With the increase of lactate, the APACHEⅡ score was also on the rise. According to the receiver operator characteristic curve（ROC）, the associated areas under the curve（AUC） that represented the ability of the variables to determine the mortality for lactate, APACHEⅡscores, and lactate combined with APACHEⅡ scores were 0.796, 0.746, and 0.809, respectively, which meant the ability of lactate was better while both of them could predict mortality, but the ability of lactate associated with APACHEⅡ scores was better than when either of them was used alone. Conclusion Lactate and APACHEⅡ scores can be independent factors for prediction of 28-day mortality for senile patients with community-acquired pneumonia. A combination of these two factors can lead to better predictions.

关 键 词：急诊 乳酸 APACHEⅡ评分 老年社区获得性肺炎 

分 类 号：R459.7[医药卫生—急诊医学]