早期乳酸清除率对脓毒症患者液体复苏治疗的指导作用

Guiding value of early lactate clearance for the treatment of fluid resuscitation in patients with sepsis in emergency department

目的探讨急诊严重脓毒症和脓毒性休克患者早期乳酸清除率与预后关系,评估其指导早期液体复苏治疗的作用。方法回顾性分析2009年7月至2012年7月在我院急诊科就诊的严重脓毒症及脓毒性休克患者的一般资料、基础乳酸值、早期乳酸清除率和预后情况。将患者按预后分为死亡组和存活组,按早期乳酸清除率高低分为高乳酸清除率组和低乳酸清除率组,比较其差异性。结果各组患者年龄、性别、基础乳酸值无显著性差异(P>0.05)。存活组患者乳酸清除率明显高于死亡组(P<0.01),高乳酸清除率组患者病死率显著低于低乳酸清除率组(P<0.01)。结论早期乳酸清除率与急诊严重脓毒症和脓毒性休克患者的预后相关,可用于指导急诊液体复苏治疗。

Objective To explore the correlation between early lactate clearance and prognosis in patients with severe sepsis or septic shock,and evaluate the directive value of early lactate clearance for fluid resuscitation.Methods The clinical data of patients with severe sepsis or septic shock in emergency department from July 2009 to July 2012 were analyzed retrospectively..Sixty-eight patients were divided into survival group and non-survival group according to prognosis,.or low lactate clearance group and high lactate clearance group according to the level of lactate clearance after 6 hours..The mortality,.the level of baseline lactate and early lactate clearance were compared respectively.Results There was no statistical difference between the two groups in age,sex and the baseline of lactate（P0.05）.The early lactate clearance in survival group was significantly higher than that in non-survival group（31.04 ±12.65 vs 14.58 ±9.11,.P 0.01）..The mortality in high lactate clearance group was significantly lower than that in low lactate group（18.92% vs 61.29%,P 0.01）.Conclusion Early lactate clearance is a good prognostic factor of severe sepsis and septic shock,and may serve as a guiding goal for early fluid resuscitation.