危重病患者早期动脉血乳酸清除率和中心静脉血氧饱和度的监测价值

Exploration of the Value of the Early Artery Lactate Clearance Rate and the Central Venous Oxygen Saturation in Critically Ill Patients

目的探讨危重病患者早期动脉血乳酸清除率、中心静脉血氧饱和度(SCVO2)的监测价值。方法观察襄阳市东风人民医院2011年1月至2012年5月收治的212例危重病患者的临床资料,测定入科即刻、6 h动脉血乳酸浓度和早期SCVO2,计算6 h乳酸清除率,并进行急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分,根据APACHEⅡ评分将患者分为4组:≤10分组(A组),11～20分组(B组),21～30分组(C组),>30分组(D组),比较四组早期乳酸清除率及SCVO2的差别,并分析其与患者预后的关系。结果 B组早期乳酸清除率、SCVO2均低于A组(均P>0.05);C组早期乳酸清除率、SCVO2均低于B组,D组亦低于C组(均P<0.05)。B组病死率高于A组,但差异无统计学意义(P>0.05),C组高于B组(P<0.05),D组高于C组(P<0.05)。死亡组APACHEⅡ评分高于存活组,早期动脉血乳酸清除率及SCVO2水平低于存活组(均P<0.01)。APACHEⅡ评分与早期乳酸清除率呈负相关(r=0.560,P<0.01),与早期SCVO2水平呈正相关(r=0.642,P<0.01)。结论早期动脉血乳酸清除率及SCVO2水平是反映危重病患者病情严重程度和预测患者转归的良好指标。

Objective To explore the monitoring value of the early artery lactate clearance rate and the central venous oxygen saturation in critically ill patients. Methods The clinical data of 212 critically ill patients admitted by Xijing Hospital of Xi＇an Fourth Military Medical University from Jan. 2011 to May 2012 Were observed. The arterial blood lactate concentration at admitting into the hospital and 6 h later and early central venous oxygen saturation were determined ,6 h lactate clearance rate was calculated, and APACHE Ⅱ scoring was done. The patients were divided into four groups according to the APACHE Ⅱ score： ≤ 10 point group （group A） ,11-20 point group （ group B） ,21-30 point group （ group C） , 〉 30 point group （ group D）. The early lactate clearance rate and central venous oxygen saturation of the four groups were compared, and their relationship with the prognosis of patients was analyzed. Results Compared with group A, early lactate clearance rate, SCVO2 were lower in group B, but there was no significant difference （ P 〉 0.05 ） ; group C early lactate clearance rate, SCVO2 were lower than group B, group D was also lower than group C （P 〈 0.05 ）. Group B mortality rate was higher than groulp A without statistically significant difference （P 〉 0.05 ） ; group C higher than group B （ P 〈 0.05 ） , and group D higher than group C （ P 〈 0.05 ）. Death group APACHE Ⅱ score was higher than the survival group, and early lactate clearance rate and SCVO2 level were lower than the survival group（ all P 〈0.01 ）. APACHE Ⅱ score was negatively correlated with early lactate clearance （ r = 0. 560, P 〈 0. 01 ） , but positively correlated with early SCVO2 level （ r = 0. 642, P 〈 0.01 ）. Conclusion Early lactate clearance rate and SCVO2level are good indicators to reflect the severity of the disease and prognosis of the patients.