严重脓毒症早期液体复苏中血乳酸清除率的应用分析  

Application analysis of blood lactate clearance rate in early fluid resuscitation of severe sepsis

作　　者：李淑娟 谭俊杰 LI Shu- juan;TAN Jun-jie.(Qingyuan Maternal and Child Health Hospital, Qingyuan 511515, China)

机构地区：[1]清远市妇幼保健院,511515

出　　处：《中国实用医药》2018年第16期12-13,共2页China Practical Medicine

摘　　要：目的探析血乳酸清除率在严重脓毒症早期液体复苏中的临床价值。方法 60例严重脓毒症患者,随机分为对照组和观察组,每组30例。对照组采用中心静脉血氧饱和度指导早期液体复苏,观察组采用血乳酸清除率指导早期液体复苏。比较观察组和对照组患者的重症加强护理病房(ICU)住院时间、总住院时间和28 d临床转归情况,并比较存活组(所有患者中存活者)和死亡组(所有患者中死亡者)患者不同时间点血乳酸值。结果观察组与对照组患者ICU住院时间、总住院时间、28 d死亡率比较差异无统计学意义(t/χ~2=0.852、0.351、0.884,P>0.05)。入院时、复苏6 h、复苏24 h、复苏72 h,存活组患者的血乳酸值均明显低于死亡组患者,差异有统计学意义(t=3.397、3.761、4.736、5.927,P<0.05)。结论血乳酸清除率指导严重脓毒症早期液体复苏的效果显著,临床价值与中心静脉血氧饱和度指导相当,且可预测严重脓毒症患者的预后,故值得进一步推广应用。Objective To investigate and analyze the clinical value of blood lactate clearance rate in early fluid resuscitation of severe sepsis. Methods A total of 60 severe sepsis patients were randomly divided into control group and observation group, with 30 cases in each group. The control group received central venous oxygen saturation guided early fluid resuscitation, and the observation group received blood lactate clearance rate guided early fluid resuscitation. The hospitalization time of intensive care unit（ICU）, total hospitalization time and the 28 d clinical outcome were compared between the observation group（all surviving patients） and the control group（all dead patients）, and the blood lactic acid value at different time points in the survival group and the death group were compared. Results The control group and observation group had no statistically significant difference in ICU hospitalization time, total hospitalization time and the 28 d clinical outcome（t/χ^2=0.852, 0.351, 0.884, P〉0.05）. At admission, 6, 24 and 72 h recovery, the survival group had obviously lower blood lactic acid value than death group, and their difference was statistically significant（t=3.397, 3.761, 4.736, 5.927, P〈0.05）. Conclusion The effect of blood lactic acid clearance on early fluid resuscitation in severe sepsis is significant, and its clinical value is similar to that of central venous oxygen saturation. It can predict the prognosis of patients with severe sepsis, so it is worthy of further promotion and application.

关 键 词：血乳酸清除率 严重脓毒症 早期液体复苏 中心静脉血氧饱和度 

分 类 号：R459.7[医药卫生—急诊医学]