乳酸清除率评估严重脓毒症患者早期液体复苏效果的可靠性

Reliability of lactate clearance rate in evaluating efficacy of early fluid resuscitation in patients with severe sepsis

目的 评价乳酸清除率评估严重脓毒症患者早期液体复苏效果的可靠性.方法 严重脓毒症患者142例,年龄28 ～ 87岁,性别不限.入ICU后静脉输注等渗晶体液,使患者6h内CVP≥8mmHg、MAP≥65 mmHg、中心静脉血氧饱和度（ScvO2）≥70％、尿量≥0.5 ml·kg-1 ·h-1行液体复苏治疗.按液体复苏治疗结局分为2组：存活组和死亡组.分别于液体复苏前即刻、液体复苏后6、12和24 h时,取中心静脉血样行血气分析,记录ScvO2;取外周静脉血样,测定乳酸浓度,计算乳酸清除率.结果 与存活组比较,死亡组液体复苏后6、12和24 h时乳酸清除率降低（P＜0.05）,ScvO2差异无统计学意义（P＞0.05）.结论 乳酸清除率可评估严重脓毒症患者早期液体复苏的效果.

Objective To evaluate the reliability of lactate clearance rate in evaluating the efficacy of early fluid resuscitation in the patients with severe sepsis.Methods One hundred and forty-two patients with severe sepsis,aged 28-87 yr,were enrolled in the study.Isotonic crystalloid fluid was infused after admission to ICU to maintain central venous pressure ≥ 8 mmHg,mean arterial pressure ≥ 65 mmHg,central venous oxygen saturation （ScvO2） ≥ 70％,and urine output ≥ 0.5 ml·kg 1 ·h-1 within 6 h.The patients were divided into 2 groups according to the treatment outcome：survival group and death group.Immediately before fluid resuscitation and at 6,12 and 24 h after fluid resuscitation,blood samples were collected from the central vein for blood gas analysis and ScvO2 was recorded.Blood samples were collected from the peripheral vein for determination of the concentration of lactate and lactate clearance rate was calculated.Results Compared with survival group,the lactate clearance rate was significantly decreased at 6,12 and 24 h after fluid resuscitation,and no significant change in ScvO2 was found in death group.Conclusion Lactate clearance rate can evaluate the efficacy of early fluid resuscitation in the patients with severe sepsis.