血乳酸、降钙素原清除率对烧伤休克患者预后的预测价值  

Predictive value of blood lactate and procalcitonin clearance rates for prognosis in patients with burn shock

作　　者：徐琦量 陈晓明 戴强[1] 施文娟[1] 周剑 蒋逸 XU Qi-liang;CHEN Xiao-ming;DAI Qiang;SHI Wen-juan;ZHOU Jian;JIANG Yi(Department of Burn Plastic Surgery,Liyang People′s Hospital,Jiangsu Province,Changzhou 213000,China;Department of Burn Plastic Surgery,the Second Affiliated Hospital of Chengdu Medical College,Sichuan Province,Chengdu 610000,China)

机构地区：[1]江苏省溧阳市人民医院烧伤整形科,江苏常州213300 [2]成都医学院第二附属医院,核工业四一六医院烧伤整形科,四川成都610000

出　　处：《河北医科大学学报》2023年第8期941-944,951,共5页Journal of Hebei Medical University

基　　金：成都市医学科研课题(2021085);江苏省卫健委医学科研面上项目(H201966)。

摘　　要：目的探究早期血乳酸清除率、降钙素原清除率对烧伤休克患者预后的预测价值。方法选取溧阳市人民医院收治的烧伤休克患者96例,统计住院28 d生存情况。对比生存组和死亡组临床资料。Logistic多因素分析影响患者预后的因素。分析早期血乳酸清除率、降钙素原清除率对烧伤休克患者死亡的预测价值。结果烧伤休克患者病死率为38.54%。死亡组吸入性损伤占比、急性生理学与慢性健康状况评分系统Ⅱ((acute physiologyand chronic health evaluationⅡ,APACHEⅡ)评分、序贯器官衰竭估计(sequential organ failure assessment,SOFA)评分均高于生存组(P<0.05),死亡组白蛋白、6 h血乳酸清除率、6 h降钙素原清除率则均低于生存组(P<0.05)。Logistic回归分析结果显示,APACHEⅡ评分(OR=2.804,95%CI:1.037~4.085)、SOFA评分(OR=2.930,95%CI:1.256~4.978)、6 h血乳酸清除率(OR=3.089,95%CI:1.843~6.012)、6 h降钙素原清除率(OR=3.428,95%CI:2.157~7.483)均为影响烧伤休克患者死亡的危险因素(P<0.05)。ROC分析显示,6 h血乳酸清除率、6 h降钙素原清除率两者联合预测烧伤休克患者死亡的AUC为0.816(95%CI:0.721~0.891),高于6 h血乳酸清除率[0.654(95%CI:0.551~0.746)]、6 h降钙素原清除率[0.703(95%CI:0.602~0.785)]单独预测烧伤休克患者死亡的AUC(P<0.05)。结论早期血乳酸清除率、降钙素原清除率对烧伤休克患者死亡的预测价值较高。Objective To explore the predictive value of early blood lactate clearance rate and procalcitonin clearance rate(PCTc)for prognosis of patients with burn shock.Methods A total of 96 patients with burn shock admitted to Liyang People′s Hospital were selected,and the 28-day survival during hospitalization was calculated.The clinical data of the survival group and the death group were compared.Multivariate Logistic analysis of factors affecting the prognosis of patients was performed.The predictive value of early blood lactate clearance rate and PCTc for death of patients with burn shock was analyzed.Results The mortality rate of burn shock patients was 38.54%.The proportion of inhalation injury,Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱscore and sequential organ failure assessment(SOFA)score in the death group were higher(P<0.05),while the albumin,6-h lactate clearance rate and 6-h PCTc in the death group were lower(P<0.05).Logistic regression analysis showed that APACHEⅡscore(OR=2.804,95%CI:1.037-4.085),SOFA score(OR=2.930,95%CI:1.256-4.978),6-h blood lactate clearance rate(OR=3.089,95%CI:1.843-6.012),and 6-h PCTc(OR=3.428,95%CI:2.157-7.483)were all risk factors affecting death of burn shock patients(P<0.05).ROC analysis showed that the AUC of combination of 6-h lactate clearance rate and 6-h PCTc in predicting the death of burn shock patients was 0.816(95%CI:0.721-0.891),which was higher than that of 6-h lactate clearance rate[0.654(95%CI:0.551-0.746)]and 6-h PCTc[0.703(95%CI:0.602-0.785)]in predicting the death of burn shock patients alone(P<0.05).Conclusion Early blood lactate clearance rate and PCTc have high predictive value for death of burn shock patients.

关 键 词：烧伤 休克 乳酸 降钙素原 

分 类 号：R644[医药卫生—外科学]