早期乳酸清除率对严重脓毒症、脓毒性休克病人的预后评估作用

The evaluation of early lactate clearance in outcome for severe sepsis and septic shock patients

目的评价早期乳酸清除率对严重脓毒症、脓毒性休克病人的预后评估作用。方法应用早期目标性液体复苏方案对30例严重脓毒症或脓毒性休克患者进行液体复苏,测定液体复苏前后的动脉血乳酸水平,计算6h乳酸清除率,并与APACHEⅡ作一致性比较。结果存活组中动脉血乳酸水平在液体复苏后有明显下降(P<0.01),死亡组中虽然动脉血乳酸水平在液体复苏后也有不同程度下降,但在复苏前后比较差异无显著性(P>0.05)。成活组6h乳酸清除率为43.2%±37.4%,死亡组为14.1%±49.7%,两者差异有显著意义(P<0.05)。在预后判断上乳酸清除率与APACHEⅡ有较高的一致性(P>0.05)。ROC曲线分析显示,当乳酸清除率<30%时,其判断患者预后的敏感度为81.25%,特异度为85.71%,阳性预测值为86.67%。结论早期乳酸清除率可作为判断严重脓毒症、脓毒性休克病人预后的一个指标。

Objective To study the value of early lactate clearance in outcome of severe sepsis and septic shock patients. Methods 30 severe sepsis or septic shock patients were selected. Artery levels were measured lactate before and after early goal-directed therapy. Then calcuated lactate clearance were calculated and compared with APACHE-Ⅱ. Results Survivors group after resuscitation showed level a lower of lactat （P〈0.01）. No significant differences were found in nonsurvivors group. Survivors and nonsurvivors had a lactae clearance of 43.2±37.4% vs 14.1±49.7% （P〈0.01）. There existed obvious correlation between lactate clearance and APACHE- Ⅱ （P〈0.05）. ROC curve showed that lactate clearance was less than 30%, and exhibited a 81.25% sensitivity, 85.71% specificity and 86.67% postive predictive value. Conclusion Early lactate clearance could be regarded as an indicator of outcome to severe sepsis and septic shock patients.