动脉血乳酸水平对急性心力衰竭患者早期风险评估的意义

The Significance of Arterial Blood Lactate Level in Patients with Acute Heart Failure for Early Risk Assessment

目的通过床旁检测急性心力衰竭(AHF)患者的动脉血乳酸水平,分析血乳酸水平与在院期间发生心血管事件的关系,探讨血乳酸水平对AHF患者早期风险评估的意义。方法选择以AHF就诊于我院急诊科的患者113例,在积极治疗疾病的基础上,记录患者自就诊至病情平稳出院期间发生的心血管事件。根据是否发生心血管事件将患者分为无事件组78例,事件组35例。患者就诊时,即刻床旁检测血乳酸水平,分析其与AHF患者在院期间发生心血管事件的关系。结果 AHF患者事件组血乳酸水平为(3.6±1.4)mmol/L,明显高于无事件组的(1.3±0.7)mmol/L,差异有统计学意义(t=-11.6,P<0.05)。应用受试者工作特征曲线(ROC曲线)分析血乳酸水平评价AHF患者在院期间发生心血管事件的敏感度和特异度,计算曲线下面积为0.959,床旁检测血乳酸水平评价AHF患者在院期间发生心血管事件的最佳临界点是2.00 mmol/L。结论血乳酸水平对于评价AHF患者在院期间是否发生心血管事件有重要价值,其最佳临界点为2.00 mmol/L。可参考血乳酸水平对AHF患者进行预后及早期风险的评估。

Objective Point of care test （POCT） the arterial blood lactate level in patients with acute heart failure （ AHF）, preliminary study the relationship between the blood lactate level and cardiovascular event in the hospital, to further ex- plore the clinical value of the blood lactate level for early risk assessment of AHF patients. Methods Choose the 113 patients of AHF who admitted in emergency department of our hospital. Record the cardiovascular events occurred during admitted to and discharge from the hospital on the base of active treatment. According whether the occurrence of cardiovascular events, patients were divided into two groups, no cardiovascular event group and cardiovascular event group. Point of care test blood lactate level when admission. Evaluate the relationship between the lactate level and the occurrence of cardiovascular in patients with AHF. Results The level of lactate in patients with AHF of cardiovascular event group was （3.6 ± 1.4） mmol/L, that was significant higher than that of no cardiovascular group, which was （ 1.3 ± 0. 7 ） mmol/L, The difference was statistically significant （ t = - 11.6, P 〈 0. 05）. Analysised of the sensitivity and specificity of lactate to evaluation the occurrence of cardiovascular events of AHF patients in the hospital, and calculate the area under the curve （ AUC）, by using the receiver operating characteristic （ROC） curve ： the AUC for lactate was 0. 959. Selected the best critical point under the ROC curve, the best critical point for lactate to evaluation the occurrence of cardiovascular events of AHF patients in the hospital was 2. 00 mmol/L. Conclusion It statistically significant for lactate to evaluate the occurrence of cardiovascular event to the patients in the hospital, the best critical point for lactate is 2.00 mmol/L. It＇s meaningful to point of care test the blood lactate level for AHF patients to evaluation prog- nosis, which may help us to do early risk assessment to patients with AHF.