急性创伤性休克患者血乳酸水平与预后的相关性研究

Correlation Study on the Blood Lactate Level and Prognosis of Patients with Acute Traumatic Shock

目的探讨观察急性创伤性休克患者血乳酸水平与预后的相关性。方法选取该院收治的120例急性创伤后失血性休克患者为研究对象,按预后分为观察组88例(存活并转出ICU者),对照组32例(未能转出ICU死亡者),回顾性分析和比较两组患者初始、12 h、24 h、4 8h血乳酸变化。结果观察组初始、12 h、24 h、48 h血乳酸水平分别为(2.36±2.54)、(2.19±2.29)、(2.13±1.15)、(2.09±1.02)mmol/L,显著低于对照组(6.88±2.63)、(4.40±2.27)、(3.91±3.38)、(4.24±3.19)mmol/L,P<0.05,提示组间比较差异有统计学意义。随着入院及治疗时间的增加,观察组存活患者的血乳酸浓度呈显著降低趋势,48 h降至(2.09±2.72)mmol/L。观察组与对照组患者入住时血乳酸水平与APACHEⅡ评分呈显著正相关,差异有统计学意义(r=0.85,P<0.05)。结论动态血乳酸监测及APACHEⅡ评分能为急性创伤性失血性休克患者的临床救治和预后提供参考依据,从而能更准确的评价患者病情,预测重症患者的死亡率提供参考。

Objective To observe and analyze the relationship between blood lactate level and prognosis of the patients with acute traumatic shock. Methods 120 cases of patients with acute traumatic hemorrhagic shock admitted in our hospital were selected as the subjects. And they were divided into the observation group （88 cases survived and were discharged from ICU） and the control group （32 cases died in the ICU）. Changes in blood lactate in the initial, 12h, 24h, 48h of two groups of patients were retrospec- tively analyzed and compared. Results In the observation group, the initial, 12h, 24h, and 48h blood lactate level was （2.36± 2.54）, （2.19±2.29）, （2.13±1.15）, （2.09＋l.02）mmol/L, respectively, significantly lower than the control group＇s （6.88±2.63）, （4.40±2.27）, （3.91 ±3.38）, （4.24±3.19）mmol/L, P〈0.05, which suggested that there were statistically significant differences be- tween the groups. Along with the increase of hospitalization and treatment time, the blood laetate concentration of the survived pa- tients in the observation group showed a significant decreasing trend, down to （2.09±2.72）mmol/L in 48h. The blood lactate levels of the patients in both groups at the time of admission showed a significant positive correlation with APACHE Ⅱ score （r=0.85, P〈 0.05）, suggesting statistical significance. Conclusion Dynamic monitoring blood lactate and APACHE Ⅱ score can provide a refer- ence for the clinical treatment and prognosis of acute traumatic hemorrhagic shock patients, so that patients＂ conditions can be e- valuated more accurately, and which provides a reference for the prediction of mortality in critically ill patients.