危重患者血乳酸水平与院内病死率的相关性研究

The study of correlation between blood lactate level and in-hospital mortality in critically ill patients

目的探讨危重患者入ICU即刻动脉血乳酸水平与院内病死率的相关性。方法 对2008-07～2010-07入住ICU的441例患者分成生存组与病死组,所有患者于入ICU即刻行动脉血乳酸测定,比较两组间急性生理学与慢性健康状况Ⅱ评分(APACHEⅡ)及生存概率(PS)、机械通气数量、住ICU天数、机械通气天数。结果①高乳酸血症的发生率为62.36%,随血乳酸水平增加院内病死率明显增加(P=0.000);②病死组乳酸水平、年龄、APACHEⅡ评分、机械通气数量明显高于生存组(P≤0.001),PS明显低于生存组(P=0.000);在疾病的构成上:患有呼吸、消化系统及其它类疾病的患者数量两组间无明显差异(P>0.05),病死组患有心血管、神经系统疾病的患者数量明显高于生存组(P≤0.002),而病死组中外科术后、复合伤的患者明显少于生存组(P≤0.001);③乳酸水平与APACHEⅡ评分成正相关(r=0.311,P=0.000);与PS、机械通气天数成负相关(分别r=-0.332,P=0.000;r=-0.144,P=0.012);与年龄、住ICU天数相关性不显著(P>0.05)。结论入ICU患者乳酸水平可以评估病情的严重程度,与危重患者院内病死率相关,提示入ICU初始乳酸监测对临床有着重要的意义。

Objective To investigate the correlation between the instant arterial blood lactate level and in-hospital mortality of critical ill patients in ICU.Method The 441 ICU patients who were hospitalized from July 2008 to July 2010 were divided into survival and dead groups.Blood lactate of all the patients were mesured at the time of admission to the ICU.Their APACHEⅡ,PS,the patients numbers used mechanical ventilation,the days that stayed in ICU,and mechanical ventilation days were compared beween survival and dead groups.Result 1） The occurrence of hyperlactatemia was 62.36%.With the blood lactate level raised（P=0.000）,the in-hospital mortality had remarkably increased.2） The blood lactate level,age,APACHEⅡ score and the patients number used mechanical ventilation in dead group were significantly higher than the survival group（P≤0.001）,while PS was significantly lower than the survival group（P=0.000）.There were no significantly difference on the patients number used the mechanical ventilation,gastrointestinal tract diseases or other kinds of diseases between the two groups（P〉0.05）,the ratio of patients with cardiovascular and neurological disease in the dead group were significantly higher than in survival group（P≤0.002）,and post-operation and trauma patients in dead group were significantly less than in survival group（P≤0.001）.3） It was positive correlation between blood lactate level and APACHEⅡ（r=0.311,P=0.000）;whereas it was negative correlation between blood lactate and PS and the mechanical ventilation days（r=-0.332,P=0.000;r=-0.144,P=0.012,respectively）.There was no correlation between blood lactate level and age,stayed days in ICU（P〉0.05）.Conclusion The instant blood lactate level of the ICU admitted patients can evaluate the disease severity and it is relevant with in-hospital mortality.It has important clinical significance to monitor the instant blood lactate level of the ICU admitted patients.