严重感染患者早期血D-乳酸水平对临床预后的影响

Predictive value of early plasma D（ -） -lactate level on the prognosis in septic patients

目的探讨严重感染患者早期血D-乳酸水平的变化及其对发生感染性休克的预测作用。方法采用分光光度法测定49例严重感染患者分别于全身性感染、严重全身性感染和感染性休克3个阶段后第1天的血D哥L酸水平及16例同期健康志愿者（对照组）的血D-乳酸水平。另外，通过比较非休克组和非直接休克组的血D-乳酸水平预测严重感染患者是否发生感染性休克。结果与对照组（1．70±0．59）mmol／L相比。全身性感染组（4．20±0．59）mmol／L、严重全身性感染组（4．52±2．16）mmol／L和感染性休克组（5．88±2．87）mmol／L的血D-乳酸水平显著升高（P〈0．01）；同全身性感染组和严重全身性感染组相比，感染性休克组的血D-乳酸水平显著升高（P〈0．05）。严重感染患者早期血D-乳酸水平与其急性生理学及慢性健康状况评分Ⅱ和序贯器官衰竭评估评分无相关性（P〉0．05）。非直接发生感染性休克患者的血D-乳酸水平（5．57±2．37）mmol／L较未发生感染性休克患者（3．854-2．01）mmol／L显著升高（P〈0．01）。结论严重感染患者早期即存在血D-乳酸水平升高，但血D-乳酸水平的变化与感染的严重程度无关；血D吼酸水平可以作为预测感染性休克发生的指标。

Objective To explore the predictive value of early plasma D（-）-lactate level on the prognosis in septic patients. Methods The plasma D（-）-lactate level was measured by spectrophotometer on Day 1 after sepsis, severe sepsis and septic shock ensured in 49 consecutive septic patients in our ICU and once in 16 healthy volunteers. Additionally, we investigated whether the early change of plasma D（-）-lactate levels could he used to predict the development of septic shock by comparing the non-shock and non-directed shock groups. Results The plasma D （-）-lactate levels significantly increased in patients with sepsis [ （4.20 ± 0. 59 ） mmol/L], severe sepsis [ （4. 52 ±2. 16） mmol/L], or septic shock [ （5.88 ±2. 87） mmol/L] when compared with normal control group [ （1.70 ±0. 59） mmol/L] （P 〈 0. 01 ）. The plasma D（-）-lactate level was significantly increased in septic shock group compared with sepsis and severe sepsis groups （P 〈 0. 05 ）. The plasma levels of D（-）-lactate was not correlated with acute physiology and chronic health evaluation Ⅱ scores and sequential organ failure assessment scores （ P 〉 0.05 ） in the early septic patients. In non-directed developed shock group, the plasma levels of D（-） - lactate on Day 1 [ （5.57±2. 37 ） mmol/L] were significantly increased than in non-developed shock group [ （3.85 ±2.01 ） mmol/L] （ P 〈 0. 01 ）. Conclusions The plasma D （-） -lactate level increases at the early stage of sepsis, although its change is not correlated with the severity of sepsis. The elevated plasma levels of D （-）-lactate can be considered as the predictive marker of septic shock.