乳酸和乳酸清除率在脓毒症病情判断及预后评估中的应用  

Evaluation of the effect of lactic acid and lactic acid clearance rate on sepsis diagnosis and prognosis evaluation

作　　者：李振华[1] 陈远鹏[1] 覃慧婵[1] LI Zhen-hua;CHEN Yuan-peng;QIN Hui-chan(Department of Critical Care Medicine,Nanning First people's Hospital,Nanning City,Guangxi Zhuang Autonomous Region,530021,China)

机构地区：[1]南宁市第一人民医院重症医学科,广西南宁530021

出　　处：《蛇志》2021年第2期154-157,共4页Journal of Snake

基　　金：广西医科大学青年科学基金资助项目(No.GXMUYSF201737)。

摘　　要：目的评价乳酸和乳酸清除率对脓毒症患者病情判断及预后评估的临床价值,为脓毒症患者诊治方案制定提供参考。方法纳入2017年1月~2019年1月在我院确诊的脓毒症患者202例作为研究对象,完善所有患者的基础检查,对患者不同阶段乳酸(LAC)、乳酸清除率(LCR)、降钙素原(PCT)、C-反应蛋白(CRP)进行监测,并同时行脓毒症相关序贯器官衰竭(SOFA)测评。根据患者确诊治疗后28 d的存活情况分为死亡组(46例)和存活组(156例),并根据患者脓毒症病情严重程度将其分为脓毒症组(55例)、严重脓毒症组(68例)和脓毒症休克组(79例),比较不同组别患者确诊时及确诊后24、48、72 h的LAC、LCR、PCT、CRP及SOFA水平,并采用Spearson分析患者LAC、LCR与脓毒症休克、死亡的相关性。结果(1)脓毒症休克组和严重脓毒症组患者确诊时及确诊后24、48、72 h的LAC、PCT、CRP及SOFA指标均高于脓毒症组(均P<0.05),而两组患者各时段的LCR均低于脓毒症组(均P<0.05);与严重脓毒症组比较,脓毒症休克组患者各时段的LAC、PCT、CRP及SOFA指标均高于严重脓毒症组(均P<0.05),而脓毒症休克组患者各时段的LCR均低于严重脓毒症组(均P<0.05)。(2)与存活组比较,死亡组患者确诊时及确诊后24、48、72 h的LAC、PCT、CRP及SOFA指标均高于存活组(均P<0.05),而死亡组患者各时段的LCR均低于存活组(均P<0.05)。(3)脓毒症患者的LAC水平与患者脓毒症病情严重程度密切相关,LAC越高,脓毒症病情越严重,并且越严重的患者治疗后LCR率越低。经Spearson分析显示,LAC与病情严重程度、死亡呈正相关(r=0.583、0.602,均P<0.05),LCR与脓毒症患者病情严重程度及死亡呈负相关(r=-0.611、-0.593,均P<0.05)。结论LAC、LCR在脓毒症患者不同阶段对脓毒症患者病情严重程度的判断及预后评估具有一定的临床价值。Objective To evaluate the clinical value of lactic acid and lactic acid clearance rate in judging the condition and prognosis of uremic patients,and to provide reference for making diagnosis and treatment plan for sepsis patients.Methods 202 sepsis patients who met the inclusion criteria in our hospital from January 2017 to January 2019 were enrolled as the research subjects.All patients were enrolled in the group at the time of diagnosis.Basic examinations of all patients were improved.Lactic acid(LAC),lactate clearance rate(LCR),procalcitonin(PCT),and C-anti-sepsis patients were examined at different stages.Protein(CRP)should be monitored and sepsis-related sequential organ failure(SOFA)should be evaluated at the same time.The patients were divided into death group(46 cases)and survival group(156 cases)according to the 28-day survival after diagnosis and treatment.According to the severity of uremia,the patients were divided into sepsis group(55 cases),severe sepsis group(68 cases)and septic shock group(79 cases).According to the above groups,the levels of lactic acid,LCR,PCT,CRP and SOFA were compared among different groups at the time of diagnosis,24 h,48 h and 72 h after diagnosis.Spearson was used to analyze the correlation coefficient r between LAC,LCR and shock and death in all patients.Results(1)The LAC,PCT,CRP and SOFA scores of septic shock group and severe sepsis group were higher than those of sepsis group at the time of diagnosis,24 hours,48 hours,72 hours after diagnosis,while those of septic shock group were higher than those of severe sepsis group(P<0.05),while LCR was lower than those of sepsis group,and those of septic shock group were lower than those of severe sepsis group(P<0.05).(2)The LAC,PCT,CRP and SOFA scores of the dead group were higher than those of the surviving group at the time of diagnosis,24,48 and 72 hours after diagnosis(P<0.05),while LCR was lower than that of the surviving group(P<0.05);(3)The LAC level of sepsis patients was closely related to the severity of sepsis,and the

关 键 词：脓毒症 乳酸 乳酸清除率 病情严重程度 预后 临床价值 

分 类 号：R631[医药卫生—外科学]