乳酸正常合并代谢性酸中毒的SAKI患者的预后分析  

Prognosis of SAKI patients with normal lactic acid and metabolic acidosis

作　　者：陈筱岚 陈晨 田磊[1] 陆晓晔[1] 杨倩[1] 朱长清[1] CHEN Xiaolan;CHEN Chen;TIAN Lei;LU Xiaoye;YANG Qian;ZHU Changqing(Department of Emergency,Renji Hospital,School of Medicine,Shanghai JiaoTong University,Shanghai,200120,China)

机构地区：[1]上海交通大学医学院附属仁济医院急诊科,上海200120

出　　处：《临床急诊杂志》2021年第7期469-472,共4页Journal of Clinical Emergency

基　　金：国家自然科学基金面上项目(No:81671881)。

摘　　要：目的:探讨乳酸水平正常但合并代谢性酸中毒的脓毒症致急性肾损伤(SAKI)患者的预后。方法:2014年1月1日—2018年12月31日期间共有319例脓毒症患者收住于上海交通大学医学院附属仁济医院急诊ICU,根据所有患者入院首次、48 h、7 d的肌酐及每小时尿量和AKI定义将197例SAKI患者纳入本研究,记录其入院首次动脉血气分析结果(pH、Lac、HCO_(3)^(-)、BE);根据28 d死亡与否分为生存组和死亡组,并比较两组患者一般资料及Lac值;进一步筛选出Lac≤2 mmol/L的SAKI患者,比较这部分Lac正常的SAKI患者血气中pH、HCO_(3)^(-)、BE对其28 d病死率的预测价值。结果:197例SAKI患者28 d病死率为37.7%(51/197),死亡组Lac值较生存组明显升高[2.2(1.3,3.2)mmol/L vs.1.5(1,2.35)mmol/L,P=0.002]。但其中有120例患者Lac≤2 mmol/L,Lac正常的SAKI患者病死率为18.3%(22/120);与生存组相比较,死亡的22例患者pH<7.35、BE<-3 mmol/L的比例明显增高(45.5%vs.11.2%、64.6%vs.33.7%,均P<0.05);BE联合pH值预测Lac≤2 mmol/L的SAKI患者28 d死亡的AUC为0.744,敏感度为81.82%,特异度为69.39%。结论:SAKI患者死亡组血气Lac值明显增高,但Lac水平正常的SAKI患者出现代谢性酸中毒时仍有较高的病死率,其中pH联合BE预测Lac正常的SAKI患者的28 d病死率效能最佳。Objective:To investigate the prognosis of septic acute kidney injury(SAKI)patients with normal lactic acid level but with metabolic acidosis.Methods:From January 1,2014 to December 31,2018,a total of 319 patients with sepsis were admitted to the emergency ICU of Renji Hospital Affiliated to Medical College of Shanghai Jiao Tong University.197 patients with SAKI were included according to the creatinine,urine volume per hour and AKI at the first admission,48 h and 7 d,and the results of arterial blood gas(pH,lactic acid,HCO_(3)^(-),BE)at the first admission were recorded;The patients were divided into two groups according to whether they died or not on the 28 th day;To further screen SAKI patients with lactic acid≤2 mmol/L,and compare the predictive value of pH,HCO_(3)^(-)and BE in blood gas for 28 day mortality of SAKI patients with lactic acid≤2 mmol/L.Results:The 28 day mortality of 197 patients with SAKI was 37.7%(51/197).The lactate value in the death group was significantly higher than that in the survival group[2.2(1.3,3.2)vs.1.5(1,2.35),P=0.002].According to the lactate value,120 SAKI patients with lactate≤2 mmol/L were screened again and divided into death group and survival group according to the 28 day outcome.The results showed that the proportion of pH<7.35 and BE<-3 mmol/L in death group was significantly higher than that in survival group(45.5%vs.11.2%,P<0.05 and 64.6%vs.33.7%,P=0.009);The AUC of BE combined with pH value in predicting 28 day mortality of SAKI patients with lactic acid≤2 mmol/L was 0.744,the sensitivity was 81.82%,and the specificity was 69.39%.Conclusion:lactic acid value in the death group of SAKI patients was significantly increased,but the mortality rate of metabolic acidosis in SAKI patients with normal lactic acid level was still high,and pH combined with BE was the best predictor of 28 day mortality in saki patients with normal lactic acid level.

关 键 词：脓毒症 急性肾损伤 代谢性酸中毒 预后分析 

分 类 号：R631.2[医药卫生—外科学]