早期乳酸水平监测对血流感染相关脓毒性休克患者预后评价的价值  

The Value of Early Lactate Monitoring in the Prognosis of Septic Shock Patients with Bloodstream Infection

作　　者：许镜清 陈晗[1] 李俊[1] 尚秀玲[1] 吴佳芳 于荣国[1] XU Jingqing;CHEN Han;LI Jun;SHANG Xiuling;WU Jiafang;YU Rongguo(Third Department of Intensive Care Unit,Fujian Provincial Hospital,FujianProvince Critical Care Medical Center,Provincial Clinical College of Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建省立医院重症医学三科,福建省重症医学中心,福建医科大学省立临床医学院,福州350001

出　　处：《福建医科大学学报》2020年第3期166-170,共5页Journal of Fujian Medical University

基　　金：福建省重症医学中心建设项目(2017-510)。

摘　　要：目的探讨ICU内血流感染所致脓毒性休克患者早期乳酸水平及乳酸清除率对其预后的预测价值。方法重症外科ICU内血流感染相关脓毒性休克患者42例,依据预后分为存活组(31例)和死亡组(11例)。收集两组患者早期复苏阶段不同时间点的乳酸水平及乳酸清除率,计算组间差异,探讨乳酸指标与预后的相关性;通过描绘各乳酸指标受试者的工作特征曲线(ROC曲线)比较ROC曲线下面积,获得与预后相关性最好的乳酸指标。结果复苏开始以后0,6,12 h的乳酸值以及6,12 h乳酸清除率存活组与死亡组间比较差别均有统计学意义(P<0.05),12 h的乳酸值的ROC曲线下面积最大。结论乳酸及乳酸清除率可用于ICU内血流感染相关脓毒性休克患者预后的评估,相比较其他时间点的乳酸指标,复苏12 h后的乳酸值与预后相关性更大。Objective To evaluate the predictive value of early lactate level and lactate clearance rate for prognosis in patients with septic shock caused by bloodstream infection in ICU.Methods From November 2013 to November 2019,42 patients with septic shock caused by bloodstream infections in surgical ICU in our hospital were collected and divided into survival group(31 cases)and death group(11 cases)according to prognosis.The lactate level and lactate clearance were collected at different time points during the early resuscitation period.The differences were calculated between the groups to confirm the correlation between the lactate variables and the prognosis.By drawing the receiver operating characteristic curve(ROC curve)of each lactate variables,the best lactate variable related to prognosis obtained throughthe area under the ROC curve.Results There were significant differences between the survival group and the death group in the lactate values at 0,6 and 12-hours after the resuscitation(P<0.05).The lactate clearance rates at the period of 6-hour and 12-hour indicated that lactate variables were correlated with the patients′prognosis.The area under ROC curve of lactate values at the 12-hour was the largest,which was more significant than other lactate variables.Conclusions Values of Lactate and lactate clearance rate can be used to evaluate the prognosis of septic shock caused by bloodstream infection in the ICU.The lactate value was more correlated with patient′s prognosis after 12-hours of resuscitation compared with other lactate variables at the different time points.

关 键 词：乳酸 代谢清除率 血流动力学 重症监护病房 预后 

分 类 号：R331.3[医药卫生—人体生理学] R349.11[医药卫生—基础医学]