休克指数与血气乳酸水平预测院前创伤性休克患者预后的对比分析  

Comparative analysis of shock index and serum lactate level in patients with traumatic shock

作　　者：姜辉 杨柳[1] 向洁 王阳光 郭杨 JIANG Hui;YANG Liu;XIANG Jie;WANG Yangguang;GUO Yang(Department of Emergency,the First People's Hospital of Changde,Changde,Hunan,415000,China)

机构地区：[1]常德市第一人民医院120急救中心,湖南常德415000

出　　处：《临床急诊杂志》2022年第2期95-99,共5页Journal of Clinical Emergency

摘　　要：目的:对比休克指数(SI)与血气乳酸水平对院前创伤性休克患者预后的预测价值。方法:选取我院2020年1月-2021年1月期间院前创伤性低血压的174例患者,对入组患者同时进行乳酸水平和SI监测,并进行分组。具体分组如下:(1)定性分组,乳酸水平≤2 mmol/L定义为正常组,>2 mmol/L定义为增高组;SI≤0.9定义为正常组,>0.9定义为增高组。(2)定量分组:按血乳酸水平分为≤2.5 mmol/L组、>2.5~5.0 mmol/L组、>5.0~7.5 mmol/L组、>7.5 mmol/L组;按SI分为≤0.9组和>0.9组。主要观察指标为患者住院7 d SOFA评分,用来评估是否存在多器官功能障碍(MODS);次要观察指标为应用血管活性药物使用率、机械通气率和住院率。结果:高乳酸水平患者住院7 d MODS发生概率增加(P<0.01)。乳酸水平增高组,患者机械通气率为18.9%(P<0.001),血管活性药物使用率为15.9%(P<0.001)。在SI正常组,随着血乳酸水平的增高,患者机械通气率、血管活性药物使用率、住院率随之升高(P<0.01);在SI增高组,血乳酸值>7.5 mmol/L的患者机械通气率、血管活性药物使用及住院率最高(P<0.01)。结论:在重症创伤性休克患者中,高血乳酸水平能够增加发生MODS的概率。同时,乳酸水平对比SI,在预测重症创伤性休克患者预后的价值更大。Objective:To compare the shock index with blood lactate level in patients with traumatic shock.Methods:Patients with pre-hospital traumatic hypotension from January 2020 to January 2021 were selected.The level of blood lactate and shock index in patients with traumatic shock was detected.Grouping as follows:(1)lactate level≤2 mmol/L was defined as normal and>2 mmol/L as higher.Shock index≤0.9 was defined as normal and>0.9 as higher.(2)blood lactate level grouping:≤2.5 mmol/L,>2.5-5.0 mmol/L,>5.0 mmol/L-7.5 mmol/L,>7.5 mmol/L.Shock index grouping:≤0.9 and>0.9.The primary outcome was the presence or absence of MODS at day 7 following injury with SOFA score.Received vasoactive drugs,mechanical ventilation and hospitalisation rate were also recorded as secondary outcomes.Results:A total of 174 trauma patients were included in this group.The risk of MODS occurrence in a week after admission was increased in patients with higher lactate level(P<0.01).Of the patients with elevated lactate level,37.31%were mechanically ventilated(P<0.001),31.34%received vasoactive drugs(P<0.001),and 79.10%were hospitalized(P<0.05).In the normal shock index group,the mechanical ventilation rate,acceptance of vasoactive drugs and hospitalization rate was increased with higher lactate level(P<0.01).In the higher shock index group,patients with lactate value>7.5 mmol/L had the highest rate of the mechanical ventilation,acceptance of vasoactive drugs and hospitalization(P<0.01).Conclusion:The higher lactate level immediately following traumatic shock is associated with increased MODS.Meanwhile,lactate level also presents as a better prognostic indicator than shock index in patients with critical traumatic shock.

关 键 词：院前 创伤性休克 休克指数 乳酸水平 

分 类 号：R631[医药卫生—外科学]