脓毒症患者中红细胞分布宽度与血乳酸关系的研究  

The relationship between red blood cell distribution width and blood lactate value in sepsispatients

作　　者：姚波[1] 刘大为[2] 柴文昭[2] 王小亭[2] 张宏民[2] Yao Bo;Liu Da-wei;Chai Wen-zhao;Wang Xiao-ting;Zhang Hong-min(Department of Critical Care Medicine,Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院重症医学科,山东青岛266000 [2]北京协和医院重症医学科,北京100730

出　　处：《中国急救医学》2018年第10期874-878,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨红细胞分布宽度（RDW）与脓毒症患者的组织灌注的关系。方法回顾性收集2013-05-2015-02期间北京协和医院重症医学科（ICU）脓毒症患者的临床资料，其中包括基线、血流动力学和实验室资料。根据RDW是否〉15％分为RDW升高组（RDW〉15％）和RDW正常组（RDW≤15％）。结果共收集300例脓毒症患者纳入研究，其中RDW升高组148例，RDW正常组152例。与RDW正常组相比，RDW升高组患者的人室及入室24h后血乳酸（Lac）和Lac〉2．0mmoL／L的比例相对较高[2．1（1．1-3．7）mmol／LVS．2．9（1．2-5．4）mmol／L，P：0．019；42．7％（65／152）VS．56．8％（83／148），P=0．021；1．3（0．9-2．4）mmol／LVS．1．6（1．1-3．5）mmol／L，P：0．039；24．5％（36／147）vs．35．9％（55／153），P=0．031]。RDw与入室及入室24h后血Lac也具有弱相关性（r=0．154，P=0．008；r=0．124，P=0．031）。但在入室及入室24h后血Lac的多元线性回归分析中发现，RDW并不是血Lac的影响因素。结论RDW〉15％的脓毒症患者比正常RDW脓毒症患者的入室及人室24h的血Lac值要高，但RDW并不是影响血Lac的因素。Objective The study investigated whether red blood cell distribution width （RDW） is associated with tissue perfusion in sepsis patients. Methods A retrospective study was conducted of patients with sepsis admitted to the intensive care unit between May 2013 and February 2015. Clinical data, hemodynamic parameters, and laboratory data were recorded. Results A total of 300 patients with sepsis were included in the study, of whom 148 were assigned to the RDW - increased （ RDW 〉 15% ） group and 152 to the RDW - normal （ RDW ≤ 15% ） group. Compared with the RDM - normal group, the RDW -increased group had a higher blood lactate concentration and contained a higher percentage of patients with lactate concentration 〉2.0 mmolfL at admission and 24 h later[2.1 （1.1 3.7） mmoL/Lvs. 2.9（1.2 -5.4）mmol/L,P=0.019;42.7%（65/152） vs. 56.8% （83/148）,P= 0.021 ; 1.3 （0.9 - 2.4） mmol/L vs. 1.6 （ 1.1 - 3.5 ） mmol/L,P = 0.039 ;24.5 % （36/147） vs. 35.9% （55/153）, P = 0. 031 ]. But only a weak correlation was detected between RDW and lactate concentration at admission and 24 h later （ r =0. 154, P = 0. 008 ; r = 0. 124, P = 0.031 ）. In multiple linear regression analysis, RDW was not a factor affecting lactate value at admission and 24 h later. Conclusion The sepsis patients with high RDW have high lactate at admission and 24 h later, butRDW is not a factor affecting lactate value.

关 键 词：脓毒症 红细胞分布宽度(RDW) 乳酸(Lac) 组织灌注 微循环 

分 类 号：R556[医药卫生—血液循环系统疾病]