早期乳酸清除率在老年重症肺炎患者预后判断中的临床价值分析

Clinical Value of Early Lactate Clearance Rate in the Prognosis of Senile Patients with Severe Pneumonia

目的探讨早期乳酸清除率在老年重症肺炎患者预后判断中的临床价值。方法选取2009年6月～2011年6月于本院进行治疗的90例老年重症肺炎患者为研究对象,将其分为存活组和死亡组,后将两组患者治疗后6h、12h及24h的乳酸清除率、氧合指数、MAP、pH、血清hs-CRP、IL-6、IFN-γ、TNF-α水平、APACHEⅡ评分进行统计及比较。结果存活组6h、12h及24h的乳酸清除率高于死亡组,MAP、氧合指数、pH、IFN-γ高于死亡组,血清hs-CRP、IL-6、TNF-α水平、APACHEⅡ评分低于死亡组,并且所有患者中乳酸清除率≥10%者死亡率、呼吸衰竭及休克发生率均低于清除率<10%,P均<0.05,均有显著性差异。结论早期乳酸清除率在老年重症肺炎患者预后判断中的临床价值较高,可以反映患者的疾病状态和炎性状态。

Objective To explore the clinical value of early lactate clearance rate in the prognosis of senile patients with severe pneumonia.Methods The clinical data of 90 senile patients with severe pneumonia hospitalized from June,2009 to June,2011 were collected and they were divided into 2 groups： survival group and death group,45 patients in each;a statistical comparison was made to the lactate clearance,oxygenation index,MAP,pH at the time point of 6,12 and 24 hours after treatment,serum hs-CRP,IL-6,IFN-γ,TNF-αof the patients in the 2 groups as well as their scores of APACHE II.Results The lactate clearance rate at the time point of 6,12 and 24 hours after treatment,MAP,oxygenation index,pH and IFN-γ of the patients in survival group were higher than those of the patients in death group while their serum hs-CRP,IL-6、TNF-α and the score of APACHE II were lower than those of the patients in death group;out of all the patients,the death rate,respiratory failure and shock occurrence in patients with lactate clearance rate ≥10% were lower than those of patients with lactate clearance rate 10%（P0.05）,the difference was of significance.Conclusions Early lactate clearance rate is of high clinical value in the prognosis of senile patients with severe pneumonia,it can reflect the disease state and inflammation state as well.