乳酸清除率对急性呼吸窘迫综合征患者的预后评估价值

Value of lactate clearance rate for evaluating prognosis of patients with ARDS

目的探讨乳酸清除率与ARDS患者预后的相关性。方法回顾性分析45例ARDS患者入院后24h内的急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,根据入院初始和入院后6h、24h测定的血乳酸值计算乳酸清除率。按照预后分为存活组和死亡组,按照6h乳酸清除率≥10%、24h乳酸清除率≥50%分为高乳酸清除率组和低乳酸清除率组。结果存活组与死亡组的年龄、性别构成比较,差异无统计学意义(P>0.05)。存活组与死亡组APACHEⅡ评分分别为16.5±4.60、31.0±8.87;初始血乳酸浓度分别为(5.48±1.88)、(9.56±4.35)mmol/L,6h乳酸清除率分别为(47.02±27.47)、(6.15±8.68)%,24h乳酸清除率分别为(71.21±22.31)、(12.68±22.83)%,组间差异均有统计学意义(P<0.05)。并且,高乳酸清除率组死亡率也明显低于低乳酸清除率组(P<0.01)。结论乳酸清除率联合APACHEⅡ评分可用于ARDS患者预后的评估。

Objective To investigate the correlation between the lactate clearance rate and the prognosis of patients with ARDS. Methods The acute physiology and chronic health evaluationII （APACHE II ） scores of 45 patients with ARDS were analyzed retrospectively in 24 hours after admission. According to lactate result at 6 hours and 24 hours after admission, lactate clearance rate were calculated. The patients were divided into high lactate clearance rate group and low lactate clearance rate group depending on 6-hour lactate clearance rate above 10% or 24-hour lactate clearance rate above 50%, The patients were di- vided into dead group and survival group according to the prognosis. Results The age and gender differences between survival group and dead group had no statistical significance （P〈0.05）. The differences between survival group and dead group in the score of APACHEII - （16.5±4.60） vs （31.0±8.87）, first blood lactic acid concentration - （5.48±1.88） vs （9.56±4.35 mmol/L）3, 6-hour lactate clearance rate （47.02±27.47） vs （6.15±8.68）%, and 24-hour lactate clearance rate （71.21 ±22.31） vs （12.68±22.83）% all had statistical significance. And the mortality rate of high lactate clearance rate group was significantly lower than that of low lactate clearance rate group （P〈0.01）. Conclusion Lactate clearance rate joint the score of APACHE II can be used to evaluate the outcome of patients with ARDS.