乳酸及APACHE II评分在脓毒症患者预后评价中的研究

Study of blood lactic acid dynamic monitoring and APACHE II score in evaluating septic shock

目的研究血乳酸动态监测及急性生理学和慢性健康评估系统II（APACHEII）评分对严重脓毒症患者治疗和预后的评价作用。方法收集73例严重脓毒症患者，用早期目标指导治疗（EGDT）开始前（0h）测得的动脉血乳酸值，分为A组（2—4mmol·L-1，28例）和B组（34mmol·L-1，45例）。测定EGDT开始后6、12、24、48h及72h的血乳酸值，并计算相应的乳酸清除率，然后比较2组患者血乳酸和乳酸清除率、APACHEII评分及病死率的变化。结果A组与EGDT（0h）的血乳酸值比较，EGDT后48h及72h乳酸值有所下降，差异具有统计学意义；B组在EGDT开始后的6h乳酸值不降反升，但随后呈下降趋势，且从12h开始的乳酸值与0h比较差异有统计学意义（P〈0．05）；EGDT开始后，B组在6、12、24、48及72h清除率及病死率与A组比较差异有统计学意义（P〈0．05）。结论血乳酸动态监测对严重脓毒症患者具有早期评估治疗及预后的作用，初始测定的血乳酸值越高其病死率越高。

Objective To investigate the treatment and prognosis of blood lactic acid dynamic monitoring in patients with severe sepsis. Methods According blood lactic acid levels which was monitored at the start of early goal detection treatment （EGDT）, 73 pa- tients with septic shock were divided into two groups： group A （blood lactic acid： 2 -4 mmol L-1, n = 28 ）and group B （blood lactic acid≥4 mmol L-1 ,n =45）. The blood lactic acid was measured at 6 h, 12 h, 24 h, 48 h and 72 h and calculating the corresponding lactic acid clearance, and then compared between the two groups of blood lactic acid and lactic acid clearance rate, APACHEII score and case fatality rate changes. Results Compared to the level of blood lactic acid at Oh, group A was obviously decreased at 48 h and 72 h after EGDT, and group B was obviously decreased at 12 h, 24 h, 48 h and 72 h after EGDT, But after the start of EGDT 6 h lactic acid value was increased （ P 〈 0.05 ） ; Compared with group A, clearance of blood lactic acid in group B was decreased obviously at 6 h, 12 h, 24 h, 48 h and 72 h, and mortality of group B was higher than that in group A （P 〈 0.05）. Conclusion Dynamically monitoring blood lactic acid is useful in the evaluating the treatment and prognosis of patients with septic shock. The results show the higher the blood lactic acid level, the higher mortality of patients with severe sepsis.Objective To investigate the treatment and prognosis of blood lactic acid dynamic monitoring in patients with severe sepsis. Methods According blood lactic acid levels which was monitored at the start of early goal detection treatment （EGDT）, 73 pa- tients with septic shock were divided into two groups： group A （blood lactic acid： 2 -4 mmol L-1, n = 28 ）and group B （blood lactic acid≥4 mmol L-1 ,n =45）. The blood lactic acid was measured at 6 h, 12 h, 24 h, 48 h and 72 h and calculating the corresponding lactic acid clearance, and then compared between the two groups of blood lactic acid and lactic acid clearance rate, APACHEII score and case fatality rate changes. Results Compared to the level of blood lactic acid at Oh, group A was obviously decreased at 48 h and 72 h after EGDT, and group B was obviously decreased at 12 h, 24 h, 48 h and 72 h after EGDT, But after the start of EGDT 6 h lactic acid value was increased （ P 〈 0.05 ） ; Compared with group A, clearance of blood lactic acid in group B was decreased obviously at 6 h, 12 h, 24 h, 48 h and 72 h, and mortality of group B was higher than that in group A （P 〈 0.05）. Conclusion Dynamically monitoring blood lactic acid is useful in the evaluating the treatment and prognosis of patients with septic shock. The results show the higher the blood lactic acid level, the higher mortality of patients with severe sepsis.