早期血乳酸清除率对心脏骤停后综合征患者预后的评估价值

The assessment value of early arterial blood lacate clearance rate in prognosis of post-cardiac arrest syndrome patients

目的探讨早期血乳酸清除率在判断心脏骤停后综合征(PCAS)患者预后的评估价值。方法回顾性分析96例心脏骤停自主循环恢复后收入ICU的患者临床资料,计算6h血乳酸清除率,同时进行APACHEⅢ评分及记录患者预后情况。根据患者入院72h转归情况,分成存活≤72h组和存活>72h组,按血乳酸清除率10%为界分成高乳酸清除率组(>10%)和低乳酸清除率组(≤10%或负值),比较各组间性别、年龄、血乳酸基础值、6h血乳酸值、6h血乳酸清除率、6h中心静脉血氧饱和度(ScvO2)、APACHEⅢ评分、休克指数等的差异性。对有统计学意义的变量进行多因素二元Logistic回归分析筛选出影响PCAS预后的独立危险因素,并绘制ROC曲线,比较危险因素曲线下面积大小。结果存活≤72h和存活>72h组在性别、年龄、血乳酸基础值、复苏6h内的APACHEⅢ评分等方面差异均无统计学意义(P>0.05);而存活>72h组的6h血乳酸清除率明显高于存活≤72h组[(32.72±15.56)%vs(21.47±18.08)%,P<0.01];高乳酸清除率组中存活>72h的比率明显高于低乳酸清除率组[73.24%vs28.00%,P<0.01]。多因素二元Logistic回归分析表明,6h血乳酸清除率、6h ScvO2是影响PCAS患者预后的独立危险因素;应用6h血乳酸清除率判断PCAS预后的ROC曲线下面积(AUC=0.830)较6hScvO2曲线下面积(AUC=0.729)大,差异有统计学意义(P<0.001),具有更好的特异度和灵敏度。结论早期血乳酸清除率可作为心脏骤停后综合征患者预后的评估重要且简便的指标之一。

Objective To investigate the assessment value of early arterial blood lacate clearance rate in prognosis of postcardiac arrest syndrome patients. Methods The clinical data of 96 patients with spontaneous circulation restoration who admitted into ICU was analyzed retrospectively,including the 6 hour lactate clearance rate, APACHEⅢ score and their prognosis. The patients were divided into survival group （live more than 72 hour） and non-survival group （live no more than 72 hour）. Based on lactate clearance rate （10% as limit）, patients were divided into low lactate clearance rate group and high lactate clearance rate group. The variability of each related indexes were compared. Independent risk factors of affecting the prognosis in the statistical significant variables were determined with multiple factor binary logistic regression analysis. ROC curves were drawn to compare the areas under the curve of different risk factor. Results There were no significant differences among those groups in different age, sex, 6 h levels of lactate and APACHEⅢ score （P0.05）. The 6 hour blood lactate clearance rate and the early blood lacate clearance rate in survival（live more than 72 hour） group were significantly more than those of non-survival （live no more than 72 hour） group [（32.72±15.56）% vs（21.47±18.08）%,P0.01]. The survival rate （live more than 72 hour） was significantly higher in the high lactate clearance group than that in the low lactate clearance group （73.24% vs 28.00%,P0.01）. Multiple factor binary logistic regression analysis showed that the 6 hour blood lactate clearance rate（6 h LAC） and the 6 hour central venous blood oxygen saturation（ScvO2） were two independent risk factors for prognosis of post-cardiac arrest syndrome patients. We use ROC analysis of 6 h LAC and 6 h ScvO2 for prognosis,the area under ROC curve of 6 h LAC was 0.830,and that of 6 h ScvO2 was 0.729,showing significant difference （P 0.001）. Conclusion Early arterial blood lacate clearance rate serves as a important and convenient index for predicting the prognosis of patients with post-cardiac arrest syndrome. It is necessary to pay attention to such patients that we can give them blood lactic acid dynamic monitoring and earlier intervention.