ICU危重症伴休克患者诊疗中血乳酸监测的临床意义分析

Analysis of clinical significance of blood lactic acid in diagnosis and treatment of critical patients with shock in ICU

目的分析危重症患者伴休克检测血乳酸、6 h乳酸清除率在病情的诊治及评估预后中的临床价值。方法选取在ICU住院的危重症伴休克患者45例为研究对象,入科时测定动脉血乳酸,经过复苏、抗休克治疗6 h后再测定动脉血乳酸,计算6 h乳酸清除率,将三组不同动脉血乳酸值、6 h乳酸清除率及病死率列表,并按预后分为存活组及死亡组,研究分析它们之间的相关性。结果血乳酸值越高提示休克越严重,病死率随着其增高而增高,而乳酸清除率则相应下降,3组不同乳酸值相比较差异有显著性(P<0.05);存活组的乳酸清除率明显高于死亡组(P<0.01)。结论动脉血乳酸水平随着低灌注程度加重、持续的时间加长而增高,与休克的严重程度呈正相关;乳酸清除率除与休克的严重程度相关外,还与液体复苏是否及时、充分是密不可分的,它是对病情的早期预警、指导治疗及评价预后的可靠指标。

Objective To analyze the clinical value of blood lactic acid test and 6 h lactic acid clearance rate in critical patients with shock in terms of their diagnosis , treatment and prognosis .Methods 45 ICU critical patients with shock were selected as subjects of the study .Their arterial blood lactic acid was determined in admission .After 6 hours＆#39;resuscitation and anti-shock treatment ,the lactic acid was re-determined and followed by calculation of 6 h lactate clearance rate .The three dif-ferent groups of arterial blood lactate value ,6 h lactate clearance rate and mortality rate were tabulated and divided into a sur-vival group and a death group based on the prognosis .Their correlation was statistically analyzed using PSSS 13.0 software.Re-sults The higher the blood lactic acid value was ,the more serious the shock and the higher the mortality rate .But the lactate clearance rate correspondingly decreased .There was statistical difference between the three groups＆#39;different lactic acid values （0.01＆lt;P＆lt;0.05）.The lactate clearance rate of the survival group was significantly higher than that of the death group （P＆lt;0.01）.Conclusion The arterial blood lactate level increases with lower perfusion and longer duration ,and is positively corre-lated with the severity of shock .Lactate clearance rate is not only correlated with the severity of shock ,but also closely related with timing and ampleness of fluid resuscitation .It can be viewed as one of the reliable indicators for early disease warning , guided treatment and prognosis evaluation .