血乳酸及乳酸清除率对休克患者预后的评估

Valuation of blood lactic acid level and lactate clearance rates in the prognosis of patients with shock

目的探讨乳酸及乳酸清除率对休克患者预后的评估作用。方法将75例休克患者,以7 d结局分为存活组44例,死亡组31例。测定两组患者出现休克时、休克后24 h、48 h及72 h血乳酸值并计算6 h乳酸清除率。结果死亡组在休克时、休克后24 h4、8 h及72 h时的血乳酸值分别为(7.3±1.4)(、5.8±1.0)(、3.8±0.5)、(2.0±0.2)mmol/L,其中休克时、休克后24 h组明显高于存活组(4.7±1.0)(、2.8±0.7)mmol/L,差异有统计学意义(P<0.05)。而死亡组计算6 h乳酸清除率(6.7±2.7)显著低于存活组(29.8±10.4),差异有统计学意义(P<0.01)。结论早期(24 h内)血乳酸水平的高低直接反映休克的严重程度,早期乳酸清除率越低,预后越差,两者联合可有效评估其预后。

Objective To discuss the valuation of blood lactic acid level and lactate clearance rates in the prognosis of patients with shock.Methods We analyzed 75 patients with shock,divided them into the survival group and death group according to their condition after 7 days of admission.There were 44 patients in the survival group and 31 patients in the death group.Their blood lactate were measured when shock occurred,24 h after shock,48 h after shock and 72 h after shock.We calculated 6 h lactate clearance rate according to the formula [value of blood lactate when shock occured the value of blood lactate 6 hours after shock/value of blood lactate when shock occurs×100%].Results In death group,the blood lactate values were（7.3±1.4）,（5.8±1.0）,（3.8±0.5）,（2.0±0.2） mmol/L,when shock occurred,24 h after shock,48 h after shock and 72 h after shock.The blood lactate values of death group when shock occurred,24 h after shock were significantly higher than that of the survival group,whose values were respectively（4.7±1.0）,（2.8±0.7）,the difference were significant（P0.05）.The 6 h lactate clearance rate of death group was（6.7±2.7） mmol/L,significantly lower than that of survival group（29.8±10.4） mmol/L,and the difference was statistically significant.Conclusion The level of early blood lactate directly reflects the severity of shock.The lower the early lactate clearance rate is,the worse the prognosis of the patients.The combination of blood lactic acid level and lactate clearance rates could effectively assess the prognosis of patients with shock.