早期动脉血乳酸监测在老年多发伤中的应用价值

Value of early arterial blood lactic acid monitoring in elderly multiple traumas

目的：评估初始血乳酸监测在老年多发伤患者中的应用价值。方法采用回顾性研究方法，收集2012年11月至2013年7月武进人民医院重症监护病房收治的老年多发伤患者78例，入ICU后立即采集动脉血进行血气分析，根据患者动脉乳酸水平分为3组（＜2mmol/L组，2～4mmol/l组，＞4mmol/L组），并记录患者基本资料，比较入ICU 24h APACHEⅡ评分、ICU住院时间、感染发生率、器官衰竭数目、24h补液量以及住院病死率；最后按患者预后分为死亡组和存活组，通过单因素及多因素回归分析影响预后的危险因素。结果（1）入科时3组基本资料差异无统计学意义（P＞0.05）；（2）住院期间3组资料在入科24h APACHEⅡ评分、24h补液量、器官功能衰竭数目、ICU住院时间以及住院病死率方面差异有统计学意义（P＜0.05），在初始收缩压、感染发生率方面差异无统计学意义（P＞0.05）；（3）多因素回归分析显示，初始乳酸水平及器官功能衰竭数目是影响老年多发伤患者预后的独立影响因素。结论初始血乳酸是老年创伤患者临床治疗中重要的监测指标，其对患者预后有一定的评估价值。

Objective To evaluate the value of the initial blood lactic acid monitoring in the elderly patients with multiple traumas. Methods A total of 78 elderly patients with multiple traumas admitted in our ICU from November 2012 to July 2013 were enrolled in this study and retrospectively analyzed. Immediately after hospitalization, their arterial blood samples were immediately collected for blood gas analysis. According to the arterial lactic acid level, these patients were divided into 3 groups： arterial lactic acid level 〈2mmol/L group, 2 to 4mmol/L group and 〉4mmol/L group. Based on the basic information and clinical data, their acute physiology and chronic health evaluation （APACHE） Ⅱ score within 24h, ICU stay duration, incidence of infection, number of failed organs, fluid intake within 24h and hospital mortality were compared among the different groups. Finally, all the patients were also divided into survival group and death group according to their prognosis. The risk factors influencing the prognosis were analyzed by univariate and multivariate logistic regression analysis. Results There was no significant difference in demographic and medical data in the above 3 groups after admission. Their APACHEⅡ score, fluid intake within 24h, number of failed organs, ICU stay duration, and hospital mortality were significantly different in the 3 groups （P〈0.05）. There was no significant difference in the initial systolic blood pressure and incidence of infection （P〉0.05）. Multivariate regression analysis showed that the number of failed organs and initial lactate level were independent risk prognostic factors in the elderly patients with multiple trauma. Conclusion The initial blood lactic acid is an important monitoring index in clinical treatment for the elderly patients with trauma, and is also of great importance to evaluate prognosis.