早期乳酸清除率预测急性上消化道出血重症患者预后的临床价值

Early lactate clearance in predicting prognosis of critically ill patients with acute upper gastrointestinal bleeding

目的评估早期乳酸清除率预测急性上消化道出血重症患者预后的临床价值。方法选取2016年1-5月在我院急诊就诊的168例急性上消化道出血重症患者,测量早期乳酸清除率,采集患者性别、年龄、病史、用药、就诊时生命体征和实验室检查资料,对全部患者随访3个月,采用单因素和多因素分析评估早期乳酸清除率与患者死亡率及再出血率的相关性。结果 168例患者的整体死亡率为23.2%,再出血率为34.5%,单因素分析显示死亡患者的早期乳酸清除率明显较生存患者低(13%vs 28%,P<0.01),随访中再次出血患者的早期乳酸清除率明显较未出血者低(12%vs 28%,P<0.01),多因素分析显示乳酸清除率是影响急性上消化道患者生存(OR:0.15;95%CI:0.04~0.51;P<0.01)及再次出血(OR:0.26;95%CI:0.08~1.04;P<0.01)的独立危险因素。结论早期低乳酸清除率是急性上消化道出血重症患者预后不佳的独立危险因素。

Objective To investigate the clinical value of early lactate clearance in predicting prognosis of patients with acute upper gastrointestinal bleeding（UIGB）. Methods One hundred and sixty-eight patients with UIGB admitted to the emergency department of Chinese PLA General Hospital from January to May in 2016 were enrolled in this study. The patients＇ demographic data, including past history, drug history, vital signs on admission and laboratory test and early lactate clearance were analyzed. All patients were followed up for 3 months, and the relationships between early lactate clearance with mortality and re-bleeding were assessed using univariate and multivariate analysis. Results Mortality and re-bleeding rates of 168 patients were 23.2% and 34.5%, respectively. Univariate analysis found that early lactate clearance of patients within 3 months death was significantly lower than that of survival patients（13% vs 28%, P〈0.01）. During follow-up period, early lactate clearance of re-bleeding patients was significantly lower than that of non-bleeding patients（12% vs 28%, P〈0.01）. Early lactate clearance was explored to be an independent risk factor of patients＇ survival（OR： 0.15; 95% CI： 0.04-0.51; P〈0.01） and re-bleeding（OR： 0.26; 95% CI： 0.08-1.04; P〈0.01） by multivariate logistic regression. Conclusion Lactate clearance may be associated with prognosis in critically ill patients with UGIB, and it can be used as a predicting indicator for mortality and recurrent bleeding.