严重脓毒症患者动脉乳酸动态监测的临床意义

The Clinical Significance of Monitoring Arterial Blood Lactic Acid Dynamic in Patients with Severe Sepsis

目的探讨严重脓毒症患者动脉乳酸及乳酸清除率的变化与预后的关系。方法对我院收治的57例严重脓毒症患者测定入院和入院6h动脉乳酸,计算6h乳酸清除率。根据24h内最差生命体征、生化指标、年龄及是否手术计算APACHEⅡ。据患者预后分为存活组和死亡组,比较2组动脉乳酸及6h乳酸清除率;绘制动脉乳酸及其清除率、APACHEⅡ的ROC曲线,比较其判断预后的价值;据APACHEⅡ分为≤20分组及>20分组,用独立样本t检验比较2组动脉乳酸及乳酸清除率;用Pearson相关分析APACHEⅡ与动脉乳酸及乳酸清除率相关性;应用Logistic回归分析影响严重脓毒症患者预后的独立危险因素。结果死亡组动脉乳酸(10.74±2.29)明显高于存活组(5.24±2.89),死亡组患者乳酸清除率(10.69±3.72)明显低于存活组(34.00±13.68),有统计学差异(P<0.01);应用APACHEⅡ判断严重脓毒症患者预后的ROC曲线下面积AUC为0.869,6h动脉乳酸AUC为0.951,6h动脉乳酸清除率AUC为0.942,差异有统计学意义(P<0.000);APACHEⅡ>20分组较≤20分组动脉乳酸升高,6h动脉乳酸清除率降低,有统计学差异(P<0.01);Pearson相关分析示初始动脉乳酸及6h动脉乳酸均与APACHEⅡ呈正相关(r=0.741,0.754,P<0.000),6h动脉乳酸清除率与APACHEⅡ呈负相关(r=-0.618,P<0.000);Logistic回归分析示6h乳酸清除率及APACHEⅡ为严重脓毒症患者预后独立危险因素。结论随着APACHEⅡ评分的增高,动脉乳酸也相应增高,且6h动脉乳酸清除率低者,病情愈严重预后愈差。早期动态监测严重脓毒症患者动脉乳酸及其清除率是判断病情严重程度和预后的良好方法,6h动脉乳酸清除率是预测严重脓毒症患者预后的有效指标。

Objective Observe change of arterial blood lactic acid and its 6h clearance in patients with severe sepsis , discuss of clinical significance on prognosis.Methods The 57 patients were collected for LAC detect, monitor it when admitted and after 6h, calculate clearance.We collected clinical variables in 24 hours,calculate APACHEⅡ.Patients were divided into dead and survival group.Calculate LAC and 6h clearance of two groups.We use ROC analysis LAC and APACHEⅡfor prognosis. Patients were divided into20and≤ 20 score group,calculate difference of LAC and 6h clearance.We calculate correlation of APACHEⅡand LAC with Pearson.We find independent risk factors with logistic regression.Results There are significant difference in LAC and its clearance,LAC of dead group is higher obviously.Under ROC cure of 6h LAC was 0.951,APACHEⅡwas 0.869;LAC of APACHEⅡ20 group was higher,and 6h clearance was lower;Pearson correlation proved LAC was positive correlated with APACHEⅡ,while 6h clearance was negative. Performing logistic regression we found 6h LAC clearance and APACHEⅡare two independent risk factors for prognosis. Conclusion The higher APACHEⅡand LAC,the lower 6h LAC clearance,the worse the prognosis.LAC can be used as an excellent prognosis index for severe sepsis patients.