动脉血乳酸水平及乳酸清除率对低血容量性休克患者液体复苏预后的评估价值  

Value of level of arterial blood lactate and lactate clearance rate in predicting prognosis of fluid resuscitation for hypovolemic shock

作　　者：葛保国[1] Ge Baoguo(Department of Critical Care Medicine,Puyang People’s Hospital,Puyang 457000,China)

机构地区：[1]濮阳市人民医院重症医学科,濮阳457000

出　　处：《中国实用医刊》2025年第4期48-51,共4页Chinese Journal of Practical Medicine

摘　　要：目的探讨动脉血乳酸水平、乳酸清除率对低血容量性休克患者液体复苏预后的评估价值。方法回顾性抽取2023年1月至2024年1月濮阳市人民医院收治的低血容量性休克患者70例,均予以液体复苏,依据临床最终结局将其分为存活组(50例)与死亡组(20例)。于入院时和入院6、12、24 h,检测并比较两组动脉血乳酸水平和乳酸清除率。以临床最终结局中存活为阴性、死亡为阳性,以动脉血乳酸水平与乳酸清除率作为预测因子预测存活(阴性)与死亡(阳性)情况,并与临床最终结局结果对照,计算动脉血乳酸水平与乳酸清除率的预测效能。结果入院时,两组动脉血乳酸水平比较,差异未见统计学意义(P>0.05);入院6、12、24 h,死亡组动脉血乳酸水平高于存活组,乳酸清除率低于存活组(P<0.05)。临床最终结局中阳性20例,阴性50例。动脉血乳酸水平预测阳性13例,阴性57例;乳酸清除率预测阳性14例,阴性56例;二者联合预测阳性19例,阴性51例。二者联合预测准确度(90.00%,63/70)、灵敏度(80.00%,16/20)更高(P<0.05)。结论与低血容量性休克液体复苏存活者比较,死亡者动脉血乳酸水平更高,乳酸清除率更低。临床上重视动脉血乳酸及清除率的评估,可为低血容量性休克液体复苏的预后判断提供依据,特别是二者联合预测价值更高。ObjectiveTo investigate the roles of arterial blood lactate level and lactate clearance rate in predicting prognosis of fluid resuscitation for hypovolemic shock.MethodsA total of 70 patients with hypovolemic shock admitted to Puyang People’s Hospital from January 2023 to January 2024 were retrospectively selected.All of them were treated by fluid resuscitation.And they were divided into the survival group(50 cases)and the death group(20 cases)according to the final clinical outcome.At the time of admission and 6,12 and 24 hours after admission,the level of arterial blood lactate and lactate clearance rate of the two groups were detected and compared.In the final clinical outcome judging,the survival was considered as negative,and death as positive.The arterial blood lactate level and lactate clearance were used as predictors to predict survival(negative)and death(positive).And the predictive performance of arterial blood lactate level and lactate clearance was calculated by comparison with the final clinical outcome results.ResultsAt the time of admission,there was no significant difference in the level of arterial blood lactate between the two groups(P>0.05).At 6,12 and 24 hours after admission,the level of arterial blood lactate in the death group was higher than that in the survival group,while the lactate clearance rate in the death group was lower than that in the survival group(P<0.05).In the final clinical outcome,there were 20 positive cases and 50 negative cases.The level of arterial blood lactate identified 13 positive cases and 57 cases negative.The lactate clearance rate identified 14 positive cases and 56 negative cases.The combination of the two indexes identified 19 positive cases and 51 negative cases.The combined of the two indexes had higher accuracy(90.00%,63/70)and sensitivity(80.00%,16/20)in prediction(P<0.05).ConclusionsCompare with the survivals after fluid resuscitation for hypovolemic shock,the deaths have higher level of lactate in arterial blood and lower lactate clearance rate.In cl

关 键 词：休克 液体复苏 动脉血乳酸 乳酸清除率 

分 类 号：R459.7[医药卫生—急诊医学]