血乳酸对胃肠道术后重症病人的临床意义

Clinical significance of blood lactate in critically ill patients after gastrointestinal surgery.

目的 评估胃肠道术后重症病人血乳酸与预后的关系。方法 回顾性分析了１９９５ 年１２ 月至１９９６年１２ 月胃肠道术后进入外科重症监护病房４４ 例病人的血乳酸变化。同时进行急性生理学和慢性健康状况评分（ Ａ Ｐ Ａ Ｃ Ｈ Ｅ Ⅱ） 。病人分为存活组和死亡组。结果 两组病人 Ａ Ｐ Ａ Ｃ Ｈ Ｅ Ⅱ评分无差别。２６ 例存活病人血乳酸２４小时内均达到正常。死亡组病人起始的血乳酸浓度明显高于存活组，而且持续时间较大，在４８ 小时内亦不能恢复正常。结论 动态监测血乳酸是判断胃肠道术后重症病人近期预后的一个良好指标。血乳酸在２４ 小时内恢复正常者，预后良好。

Objective To evaluate the relationship between postoperative blood lactate levels and outcome in critically ill patients.Methods 44 patients admitted directly to SICU after gastrointestinal surgery from December 1995 to December 1996 were studied retrospectively.Serial blood lactate levels and APACHE Ⅱ score were measured.Patients were analyzed with respect to survival versus nonsurvival.Results There was no statistically significant difference between the two groups with respect to APACHE Ⅱ score.All 26 patients whose lactate level normalized within 24 hours survived.Nonsurvivors whose lactate did not normalized in 48 hours had a significantly higher initial lactate level and a significantly longer time than survivors.Conclusion Serial determination of blood lactate level is a good prognostic factor for short-term survival in critically ill patients after gastrointestinal surgery.The ability to clear lactate to normal levels within 24 hours ensures survival.