碱剩余早期动态变化与严重脓毒症和脓毒症休克患者预后的关系

Relationships between early change of base excess and the prognosis of patients with severe sepsis and septic shock

目的探讨碱剩余早期动态变化对严重脓毒症和脓毒症休克患者预后的早期评估作用。方法采用回顾性分析方法，记录严重脓毒症和脓毒症休克患者入院后碱剩余及急性生理和慢性健康状况评分Ⅲ（APACHEⅢ），分析碱剩余与APACHEⅢ评分及脓毒症预后的关系，并比较不同碱剩余组预后的情况。结果死亡组和存活组碱剩余值及早期变化趋势明显不同（P〈0．05，P〈0．01），不同碱剩余组间预后比较差异有统计学意义（P〈0．05，P〈0．01），碱剩余与APACHEⅢ评分间有较好的一致性。早期碱剩余越高，预后越好，治疗后碱剩余恢复较快组预后良好。结论碱剩余是评估严重脓毒症和脓毒症休克严重性及预后较好的指标，其应用价值可与APACHEⅢ评分媲美，而且两者联合预测效果更好。

Objective To explore the clinical value of early changes of base excess in the prognostic evaluation of patients with severe sepsis and septic shock. Methods To retrospectively analyze and record the base excess and acute physiology and chronic health evaluation（APACHE） Ⅲ of the severe sepsis and septic shock patients after admission to hospital. To study the relationship of base excess with APACHE Ⅲ and the prognosis. The prognosis of different base excess groups were compared. Results The base excess and early changes between survival groups and nonsurvival groups were different,and there was statistical significance （ P 〈 0. 05, P 〈 0.01 ）. The prognosis of different base excess groups had statistical significance（ P 〈0. 05, P 〈0.01 ）. Base excess and APACHE Ⅲ had a better consistency. The prognosis was better in higher base excess group, and the patients with quicker recovery after treatment had better prognosis. Conclusion Base excess is a better marker to assess the severity and prognosis in severe sepsis and septic shock patients, its value could be comparable to the APACHE Ⅲ score, predictive results could be better by taking joint action.