早期乳酸清除率评估外科严重脓毒症预后的临床价值研究

Clinical significance of early lactate clearance in patients with severe sepsis after surgery

目的评估早期乳酸清除率与外科手术后严重脓毒症病人预后的关系。方法前瞻性观察并收集中山大学附属第一医院外科2004年7月至2007年6月因术后严重脓毒症进入外科重症监护病房206例病人的APACHEⅡ评分、入ICU6h动脉血乳酸清除率及病人预后的相关资料。将病人分成存活组和死亡组,高乳酸清除率组和低乳酸清除率组,比较其差异性。结果各组年龄、性别、APACHEⅡ评分和基础血乳酸值差异无显著性意义(P>0.05)。存活组乳酸清除率明显高于死亡组[(28.8±11.7)%对(15.2±11.2)%,P<0.01];高乳酸清除率组病死率均明显低于低乳酸清除率组(26.7%对51.1%,P<0.001)。结论早期乳酸清除率可用于评估外科术后严重脓毒症的预后。

Objective To evaluate the correlation between the prognosis and the early lactate clearance in severe sepsis patients after surgery. Methods The clinical data of 206 patients with severe sepsis after surgery admitted between July 2004 and June 2007 in the First Affiliated Hospital of Sun Yat-sen University was analyzed prospectively. APACHE Ⅱ score, the mortality and the lactate clearance after 6 hours were measured. The patients were divided into survival group and nonsurvival group, low lactate clearance group and high lactate clearance group. Results There was no statistical difference among those groups in age, sex, APACHE Ⅱ score and the baseline of lactate. The early lactate clearance in survival group was significantly more than that in the nonsurvival group （28. 8 ± 11.7 vs 15. 2 ± 11.2%, P 〈0. 01 ）. The mortality was in high lactate clearance group significantly less than that in the low lactate group （26.7% vs 51.1%, P 〈 0. 001 ）. Conclusion The early lactate clearance is a good prognostic factor of severe sepsis after surgery.