血乳酸、碱缺失、降钙素原与肺炎伴脓毒性休克预后的关系

Relationship of blood lactate,base deficit and procalcitonin to prognosis of patients with pneumonia companion septic shock

目的探讨血乳酸、碱缺失、降钙素原三种生物标记物与肺炎伴脓毒性休克严重程度及预后的关系。方法对重症监护室(ICU)收治的98例肺炎伴脓毒性休克患者,检测入ICU时、6 h、24 h三种生物标记物浓度,同时入ICU时对其进行APACHEⅡ评分,以6 h乳酸清除率10%为界分为两组,比较两组APACHEⅡ评分、多器官功能障碍综合征(MODS)发生率及病死率;同时根据28 d是否存活分为存活组及死亡组,对两组各时间点三种生物标记物进行比较;分析三种生物标记物与APACHEⅡ评分相关性。结果 6 h乳酸清除率≥10%组APACHEⅡ评分、MODS发生率及病死率比6 h乳酸清除率<10%组低(P<0.05);存活组血乳酸、降钙素原比死亡组明显低(P<0.01),存活组碱缺失比死亡组高(P<0.05);血乳酸、降钙素原与APACHEⅡ评分正相关(P<0.05),碱缺失与APACHEⅡ评分负相关(P<0.05)。结论三种生物标记物可作为评价肺炎伴脓毒性休克患者疾病严重程度及预后较可靠指标,血乳酸和降钙素原越高,碱缺失越低,提示预后不良。

Objective To investigate the relationship of blood lactate,base deficit and procalcitonin to prognosis of patients with pneumonia companion septic shock. Methods 98 patients with pneumonia companion septic shock were enrolled in the study. Blood lactate,base deficit and procalcitonin were detected at the 6th and 24th hours after admission and APACHE Ⅱ was performed. All patients were divided into two groups by lactate clearance rate of10%. The APACHE Ⅱ score,the incidence of organ dysfunction syndrome（ MODS） and mortality were compared.At the same time,all patients were divided into the survival group and the non-survival group by whether they were survival 28 days after admission. The correlation of three kinds of biological markers and APACHE Ⅱ score were analyzed. Results APACHE Ⅱ score and incidence of MODS and mortality in the 6 h lactate clearance rate ≥10%group were lower than those in the 6 h lactate clearance rate 10% group（ P〈0. 05）. The lactate and procalcitonin levels in the survival group were significantly lower than those in the non-survival group（ P〈 0. 01）. The base deficit level in the survival group was higher than that in the non-survival group（ P〈0. 05）. Analysis of lactate,procalcitonin and APACHE Ⅱ score showed a positive correlation（ P〈0. 05）,and base deficit and APACHE Ⅱ score showed a negative correlation（ P〈0. 05）. Conclusion Blood lactate,base deficit and procalcitonin can be used to be reliable index that evaluate the severity and prognosis of the disease of patients with pneumonia companion septic shock.The higher blood lactate and procalcitonin and the lower base deficit indicate poor prognosis.