动态监测动脉血乳酸对感染性休克患者预后的评价

Evaluation of the Prognosis of Septic Shock Patients Based on Monitoring Lactate Concentration in Arterial Blood

目的探讨动脉血乳酸动态监测指标与感染性休克患者预后的关系。方法将96例感染性休克伴有动脉血乳酸水平升高(≥2.0 mmol/L)的患者根据是否存活分为死亡组(46例)和存活组(50例),比较两组动脉血乳酸监测指标(动态乳酸水平、乳酸清除率、乳酸持续升高时间)、急性生理和慢性健康状况Ⅱ评分及多脏器功能障碍综合征发生率。结果死亡组入ICU后0、6、24和48 h的动脉血乳酸水平、APACHEⅡ评分、多脏器功能障碍综合征发生率均显著高于存活组(P<0.05),早期目标导向治疗达标率明显低于存活组(P<0.01)。存活组6、24 h乳酸清除率明显高于死亡组(P<0.01),6 h乳酸清除率≥10%时病死率明显降低。多元Logistic回归分析显示24 h动脉血乳酸水平及6 h乳酸清除率是感染性休克患者死亡的独立危险因素。结论动态动脉血乳酸水平、6 h乳酸清除率是评估感染性休克患者预后的良好指标。

Objective To explore the relationship between dynamic lactic acid monitoring indexes and prognosis in patients with septic shock.Methods 96 patients with septic shock and elevated arterial blood lactic acid level（≥2.0 mmol/L）were enrolled in this study and were divided into death group（n=46）and survival group（n=50）based on the prognosis.Differences in their lactic acid indexes（including dynamic lactate level,lactate clearance rate,duration of lacticemia）,acute physiology and chronic health evaluation Ⅱ（APACHEⅡ）score,incidence of multiply organ dysfunction syndrome（MODS）were compared.Results Lactate at 0,6,24 and 48 hour,APACHEⅡscore,incidence of MODS of the death group were significantly higher than the survival group（P0.05）;and compliance rate of early goal-directed therapy（EGDT）of the death group was significantly lower than the survival group（P0.01）.The lactate clearance rate of 6-and 24-hour in survival group were significantly higher than death group（P0.01）.The lactate clearance rate of 6-hour≥10% had significantly lower mortality.By using a multivariate logistic regression analysis,it showed that the lactate at 24 hour and the lactate clearance rate of 6 hour were the independent predictive factors of survival.Conclusion Dynamic lactate level and the lactate clearance rate of 6 hour are the practical prognostic factors of survival in patients with septic shock.