早期乳酸清除率评估重型颅脑创伤合并高乳酸血症患者预后的研究

Clinical significance of early lactate clearance in patients of severe traumatic brain injury with lactic acidosis

目的评估重型颅脑创伤合并高乳酸血症患者6小时乳酸清除率与预后的关系。方法前瞻性研究,选取余姚市人民医院神经外科和重症医学科病房2010年6月至2012年6月入院的重型颅脑创伤合并高乳酸血症患者38例,测定治疗前及治疗后6小时动脉血乳酸,计算6小时乳酸清除率。以患者入住神经外科或重症医学科病房为研究起点,患者出院(最长随访者为28天)或死亡为研究终点,将患者分为存活组(31例)和死亡组(7例),以6小时血乳酸清除率10%为界限分为高乳酸清除率(≥10%)组(25例)和低乳酸清除率(<10%)组(13例)。比较存活组和死亡组6小时乳酸清除率差异,高乳酸清除率组和低乳酸清除率组之间28天死亡率差异。结果各组年龄、性别、治疗前GCS评分、APACHEⅡ评分、基础血乳酸值均无统计学差异;存活组早期乳酸清除率显著高于死亡组[(20.68±14.67)%vs(6.21±10.40)%,P<0.05];高乳酸清除率组28天死亡率显著低于低乳酸清除率组(8.70%vs62.5%,P<0.05);高乳酸清除率组生存率显著高于低乳酸清除率组(92.0%vs61.5%,P<0.05)。结论早期乳酸清除率可作为评估重型颅脑创伤合并高乳酸血症患者预后的指标。

Objective To evaluate the correlation between the prognosis and the early lactate clearance in patients of severe traumatic brain injury with lactic acidosis. Methods 38 patients of severe traumatic brain injury with lactic acidosis who were admitted into our Hospital from June 2010 to June 2012 were observed. Arterial blood lactate was measured at baseline and 6 hours later after admission for calculating 6h lactate clearance. The time of hospitalizing were taken as the starting point, and the time of discharging （the longest follow-up for 28 days） or death were taken as the endpoint of the study. Patients were divided into survival group （31 cases） and death group （7 cases）. In addition, patients were also divided into 2 groups by blood lactate clearance rate： high lactate clearance rate （≥ 10%） group （25 cases） and low lactate clearance rate （〈10%） group （13 cases）. Lactate clearance was compared between the survival group and the death group. 28-day mortality differences was compared between the high lactate clearance group and the low lactate clearance group. Results There was no statistical difference between the two groups in age, sex, pretreatment GCS score, APACHEⅡscore and the baseline of lactate. The early lactate clearance in survival group was significantly higher than that in the death group, （20.68＋14.67）% vs （6.21＋10.40）%,P〈0.05. The 28-day mortality in high lactate clearance group was significantly less than that in low lactate clearance group, 8.70% vs 62.5% ,P〈0.05. The Survival rate in high lactate clearance group was significantly higher than that in low lactate clearance group, 92.0% vs 61.5% ,P〈0.05. Conclusion The early lactate clearance is a good prognostic factor of severe traumatic brain injury with lactic acidosis.