动态监测动脉血乳酸浓度预测感染性休克患者的预后研究

Study on the Prognosis in Patients with Septic Shock by Dynamic Monitoring the Lactate Level of Arterial Blood

目的探讨感染性休克患者动脉血乳酸浓度及血乳酸清除率与预后的关系。方法选择2008年1月—2010年6月收住我院ICU的30例感染性休克患者,采用早期目标指导治疗(EGDT),按患者的预后分为存活组和死亡组。测定入住ICU即刻、入院6 h动脉血乳酸浓度,计算6 h乳酸清除率,以乳酸清除率≥10%为界分为高乳酸清除率组和低乳酸清除率组,比较两组患者的28 d病死率。结果存活组与死亡组患者入院即刻血乳酸、6 h血乳酸浓度及6 h乳酸清除率比较,差异均有统计学意义(P<0.01)。6 h内高乳酸清除率组与低乳酸清除率组患者病死率比较,差异有统计学意义(P<0.01)。结论感染性休克患者动脉血乳酸浓度增高及6 h低乳酸清除率患者预后不良,6 h乳酸清除率具有良好的评估预后的作用。

Objective To evaluate the correlation between the lactate in artery blood,lactate clearance rate and prognosis in patients with septic shock.Methods Thirty patients with septic shock from January 2008 to June 2010 were treated by early goal-directed therapy（EGDT）.They were divided into survival group and dead group by prognosis.Blood concentration of lactate after admission to ICU and 6-hours lactate were detected,and 6-hour lactate clearance rate were calculated.They were divided into low lactate clearance rate group and high lactate clearance rate group depending on whether the rate below 10% or above 10%.Compare the 28-day mortality rate between the two groups.Results Significant differences of the lactate level after admission,6 hours and the lactate clearance rate of 6 hours were found between death group and survival group（P〈0.01）.The mortality rate of patients with high lactate clearance rate within 6 hours and low lactate clearance rate within 6 hours showed significant difference（P〈0.01）.Conclusion Patients with high arterial blood concentration of lactate and low 6-hour lactate clearance rate have an unfavorable prognosis.The 6-hour lactate clearance rate can be used as a good marker to predict prognosis of septic shock patients.