血清降钙素原、乳酸清除率及危重疾病评分对脓毒症预后的评估价值

Evaluation Value of Serum Procalcitonin, Lactic Acid Clearance Rate and Acute Physiology and Chronic Health EvaluationⅡ to Sepsis

目的：探讨血清降钙素原（procalcitonin,PCT）、乳酸清除率及危重疾病评分（Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ）对脓毒症预后的评估价值。方法：选择2011年2月～2013年2月期间我院收治的脓毒症休克及严重脓毒症患者92例,其中脓毒症休克37例,严重脓毒症者55例;存活60例,死亡32例。对本组患者血清PCT、乳酸清除率及APACHEⅡ进行分析,探讨以上指标对其预后的评定价值。结果：1死亡组血清PCT、APACHEⅡ、乳酸分值均大于存活组,左心射血分数（Left ventricular ejection fraction,LVEF）及早期乳酸清除率小于存活组,对比具有统计学意义（P〈0.01或P〈0.05）;2脓毒性休克组血清PCT、APACHEⅡ、乳酸分值均大于严重脓毒症组,LVEF及早期乳酸清除率小于严重脓毒症组,对比具有统计学意义（P〈0.01或P〈0.05）;3本组乳酸与APACHEⅡ呈正相关性（P〈0.01）,早期乳酸清除率与APACHEⅡ呈负相关性（P〈0.01）。结论：PCT、乳酸清除率及APACHEⅡ评分可以作为脓毒血症预后的有效评估指标,通过对PCT、乳酸清除率及APACHEⅡ评分监测以便尽早采取积极的治疗措施,改善预后情况。

Objective： To explore the significance of serum procalcitonin（PCT）, lactate clearance rate and Acute Physiology and Chronic Health Evaluation Ⅱ（ APACHE Ⅱ） in the evaluation of sepsis. Methods： 92 patients with septic shock and severe sepsis were selected in our hospital from February 2012 to February 2013, including37 cases of septic shock and 55 cases of severe sepsis patients; 60 cases survived, 32 cases died. The serum levels of PCT, lactate clearance rate and APACHE Ⅱ analysis, discussion of the assessment value of above indexes on the prognosis. Results： 1 The serum levels of PCT, APACHE Ⅱ, lactate values of death group were greater than the survival group, LVEF and the early lactate clearance rate is less than the survival group（P0.01 or P0.05）; 2 Septic shock group serum PCT, APACHE Ⅱ scores, lactic acid more severe sepsis group, LVEF and early lactate clearance rate less than severe sepsis group（P〈0.01 or P〈0.05）; 3 The lactic acid and APACHE Ⅱ were positively correlated（P〈0.01）, the early lactate clearance rate was negatively correlated with APACHE II（P〈 0.01）. Conclusion： PCT, lactate clearance rate and APACHE Ⅱ can be used as an effective evaluation index of sepsis prognosis, through the PCT, lactic acid clearance rate and APACHE Ⅱ monitoring so as to take active treatment, improve the prognosis of the patients.