6h乳酸清除率评估慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭患者预后的临床意义

Clinical Significance of 6-hour Lactate Clearance Rate for Prognosis of Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease Combined with Type Ⅱ Respiratory Failure

目的探讨6 h乳酸清除率评估慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭患者预后的临床意义。方法选择78例AECOPD合并Ⅱ型呼吸衰竭患者为研究对象,测定治疗前、治疗6 h后动脉血乳酸、动脉血气,按是否存活将患者分成存活组和死亡组;以动脉血乳酸清除率10%为界限分为高乳酸清除率(≥10%)组和低乳酸清除率(<10%)组。比较存活组和死亡组、高乳酸清除率组和低乳酸清除率组观察指标有无差异。结果存活组与死亡组治疗前动脉血乳酸、pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、肺泡气动脉血氧分压差[P(A-a)O2]比较,差异均无统计学意义(P>0.05);治疗6 h后患者动脉血乳酸、pH值、PaO2、PaCO2、P(A-a)O2比较,差异均有统计学意义(P<0.01)。存活组患者6 h乳酸清除率为(41.8±9.2)%,高于死亡组患者的(10.9±3.3)%,差异有统计学意义(P<0.05)。高乳酸清除率组与低乳酸清除率组治疗前动脉血乳酸、pH值、PaO2、PaCO2、P(A-a)O2比较,差异均无统计学意义(P>0.05);治疗6 h后患者动脉血乳酸、pH值、PaO2、PaCO2、P(A-a)O2比较,差异均有统计学意义(P<0.01)。高乳酸清除率组患者病死率(21.3%)低于低乳酸清除率组患者(41.9%),差异有统计学意义(P<0.05)。结论 6 h乳酸清除率可用于评估AECOPD合并Ⅱ型呼吸衰竭患者的预后。

Objective To study the clinical significance of 6-hour lactate clearance rate for the prognosis of patients with acute exacerbations of chronic obstructive pulmonary disease（AECOPD） combined with type Ⅱ respiratory failure.Methods Arterial blood lactate and blood gas were determined before treatment and 6 hours after treatment.The 6-hour lactate clearance rate was calculated in 78 patients with AECOPD combined with type Ⅱ respiratory failure.The patients were divided into survival group and death group,and also divided into high lactate clearance rate group（≥10%） and low lactate clearance rate group（10%）,and the clinical values of 6-hour lactate clearance rate were compared.Results The arterial blood lactate,pH value,PaO2,PaCO2,and P（A-a）O2 showed no significant differences before treatment between survival group and death group（all P0.05）,but were significantly different 6 hours after treatment（all P0.01）.The 6-hour lactate clearance rate in the survival group（（41.8±9.2）%） was significantly higher than that in death group（（10.9±3.3）%）（P0.05）.The arterial blood lactate,pH value,PaO2,PaCO2,and P（A-a）O2 showed no significant differences before treatment between high lactate clearance rate group and low lactate clearance rate group（P0.05）,but were significantly different（all P0.01） 6 hours after treatment.The mortality rate in the high lactate clearance rate group（21.3%） was significantly lower than that in the low lactate clearance rate group（41.9%）（P0.05）.Conclusion The 6-hour lactate clearance rate has a predictive value for the prognosis of patients with AECOPD combined with type Ⅱ respiratory failure.