早期乳酸清除率对呼吸衰竭患者预后判定的意义

Clinical significance of early lactate clearance rate in patients with respiratory failure

目的探讨早期乳酸清除率对呼吸衰竭患者的临床意义。方法采用前瞻性研究，选取东南大学附属中大医院呼吸科病房2005年8月至2009年4月人院的110例呼吸衰竭患者，其中男59例，女51例，年龄35～84岁，平均（59±22）岁；Ⅰ型呼吸衰竭患者50例，Ⅱ型呼吸衰竭患者60例。对110例患者进行急性生理学及慢性健康状况评价Ⅱ（APACHEⅡ）评分，测定治疗前、治疗后6hz动脉血乳酸及动脉血气，计算6h乳酸清除率。以患者入住呼吸科病房作为研究起点，以患者痊愈出院或死亡作为研究终点，将患者分成存活组（82例）和死亡组（28例），以动脉血乳酸清除率10％为界限分为高乳酸清除率（≥10％）组（68例）和低乳酸清除率（〈10％）组（42例）。比较存活组和死亡组、高乳酸清除率组和低乳酸清除率组之间相关数值的差异。组间比较采用t检验，治疗前、后的比较采用组内配对t检验，率的比较采用x。检验。结果存活组与死亡组、高乳酸清除率组与低乳酸清除率组患者比较，治疗前动脉血乳酸、APACHEⅡ评分、pH值、PaO2、PaCO2及氧合指数等差异均无统计学意义；而治疗6h后两组患者动脉血乳酸、PaO2、PaCO2及氧合指数的差异均有统计学意义（均P〈0．05），但是pH值、APACHEⅡ评分两组间比较差异均无统计学意义；存活组6h乳酸清除率（31％±11％）明显高于死亡组（14％±6％）（χ2=161．2，P〈0．01）；高乳酸清除率组病死率为15％（10／68）明显低于低乳酸清除率组的43％（18／42），差异有统计学意义（χ2=178．4，P〈0．01）。结论早期乳酸清除率可作为判断呼吸衰竭患者预后的一个指标。

Objective To investigate the clinical significance of early lactate clearance rate in patients with respiratory failure. Methods A prospective clinical trial was carried out. A hundred and ten patients with respiratory failure , including 59 males and 51 females, with mean age （59 ± 22） yrs were admitted into the respiratory ward in affiliated Zhongda Hospital of Southeast University from August 2005 to April 2009 . There were 50 cases of type Ⅰrespiratory failure and 60 cases of type Ⅱrespiratory failure. The acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） score was evaluated, 6 h arterial blood lactate and arterial blood gas analysis were measured before and after the treatment, and then 6 h lactate clearance rate were calculated in all the 110 patients. Patients were divided into the survival group （80 cases） and the death group （28 cases） from hospital admission to the study end of discharging or death of the patients. The high lactate clearance rate group （68 cases） was defined as a lactate clearance rate ≥10% , and the low lactate clearance rate group （42 cases） with a lactate clearance rate 〈 10%. Data were compared between the survival group and the death group, the high lactate clearance rate group and the low lactate clearance group. T test was used in the comparison between groups, group paired t test was used in the comparison between before and after the treatment, and chi-square test was used in the comparison between rates. Results There were no statistical differences in arterial blood lactate, APACHE Ⅱscore, pH value, PaO2, PaCO2 and oxygenation index between the survival group and the death group or between the high lactate clearance rate group and the low lactate clearance rate group before the treatment. There were statistical differences in arterial blood lactate, PaO2, PaCO2 and oxygenation index between groups 6 h after the treatment （ P 〈 0.05 ） except for pH values and APACHE Ⅱscore. The 6 h lactate clearance rate of the survival group （31% ±11% ） was significantly higher than that of the death group （ 14%± 6% ）（χ2 = 161.2, P 〈0.01 ）. Mortality of the high lactate clearance rate group （15%） was significantly lower than that of the low lactate clearance rate group （43%） （χ2 = 178.4, P 〈 0.01 ）. Conclusion Early lactate clearance rate could be used as a marker for prognosis of patients with respiratory failure.