早期乳酸清除率和PCT在急诊脓毒性休克患者预后中的评估价值

Prognostic value of early lactate clearance rate and procalcitonin in emergency patients with septic shock

目的探讨早期乳酸清除率和降钙素原(PCT)在急诊脓毒性休克患者预后的评估价值。方法检测65例实施早期目标化治疗(EGDT)急诊脓毒性休克患者入院时和入院6h静脉血乳酸、PCT等指标,并计算6h乳酸清除率;根据是否发生多器官功能障碍综合征(MODS)分为MODS组和非MODS组;根据28d转归分为死亡组和存活组;以6h乳酸清除率≤10%为阈值分为高乳酸清除率组和低乳酸清除率组;以血清PCT活性是否高于本组研究病例中位数分为高PCT组和低PCT组。结果 MODS组和死亡组早期乳酸清除率分别低于非MODS组和存活组,MODS组和死亡组PCT分别高于非MODS组和和存活组,差异均有统计学意义(P均<0.05)。低乳酸清除率组和高PCT组病死率和MODS发生率分别高于高乳酸清除率组和低PCT组,差异均有统计学意义(P均<0.05)。结论早期乳酸清除率和PCT对急诊脓毒性休克患者预后的评估有较大价值。

Objective To evaluate the prognostic value of early lactate clearance rate and procalcitonin （PCT） in emergency patients with septic shock. Methods 65 emergency patients with septic shock were treated with early goaldirected therapy （EGDT）, their venous blood lactate and PCT were measured at admission and the treatment, lactate clearance was calculated in 6 hours. According to multiple organ dysfunction syndrome （MODS） and death within 28 d, the early lactate clearance rate and PCT between the two groups were compared. They were also divided into two groups according to the early lactate clearance rate and the median of PCT. The fatality rate and incidence rate of MODS between the two groups were compared. Results In the MODS group and the death group, the early lactate clearance rate was lower than the non-MODS group and survival group, while the PCT was higher （P〈0.05）. The mortality and incidence rate of MODS in the early low lactate clearance rate group and high PCT group was higher than the early high lactate clearance rate group and low PCT group, respectively （P〈0.05）. Conclusion Early lactate clearance rate and PCT can be used effectively to evaluate the prognosis of emergency patients with septic shock.