乳酸清除率评估重度脓毒症患者预后的临床分析

Prognosis of severe sepsis patients assessed by lactate clearance rate

目的回顾性研究乳酸清除率与重度脓毒症患者预后的相关性。方法收集247例重度脓毒症患者入ICU后的APACHEⅡ评分、脓毒症休克发生率、入ICU 12 h后乳酸清除率及患者转归。分别将病例分成存活组和死亡组,高乳酸清除率组和低乳酸清除率组,比较其差异的统计学意义。结果各组年龄、性别、APACHEⅡ评分和初始血乳酸浓度比较差异均无统计学意义(P＞0．05)。存活组脓毒症休克发生率明显低于死亡组(31．03% vs 83．33%,P＜0．01),乳酸清除率明显高于死亡组[(31．86±16．34)% vs(14．77±10．35)%,P＜0．01]；高乳酸清除率组脓毒症休克发生率、病死率均明显低于低乳酸清除率组(29．45% vs 90．48%,30．67% vs 85．71%,P均＜0．01)。APACHEⅡ评分与病死率无相关性。结论乳酸清除率可用于早期评估重度脓毒症患者的预后转归。

Objective To retrospectively analyze the correlation between the prognosis and the lactate clearance rate in severe sepsis patients. Methods The data of 247 severe sepsis patients were col- lected, including the score of APACHE Ⅱ after admission to ICU, the morbidity of septic shock, the lactate clearance rate after 12 hours in ICU and the patients＇ prognosis. A total of 247 cases were divided into survival group and dead group, low lactate clearance rate group and high lactate clearance rate group, and the differences between them were compared for statistical significance. Results There were no differences in age, sex, the score of APACHE Ⅱ after admission to ICU and the initial blood concentration of lactate （ P 〉 0.05）. In survival group, the morbidity of septic shock was significantly less （ 31.03 % vs 83.33% ,P 〈0.01）, but the lactate clearance rate was significantly higher than in dead group[ （ 31.86 ± 16. 34}% vs （ 14.77± 10.35）%, P 〈 0.01 ] ; In high lactate clearance rate group, the morbidity of septic shock and the mortality were significantly lower than in the low lactate clearance rate group（ 29.45% vs 90.48%, P 〈0.01 ; 30.67% vs 85.71%, P 〈0.01 }. ConcIusion The lactate clearance rate can predict the prognosis of severe sepsis even in early phase.