不同时间点乳酸清除率对亚低温脑复苏患者短期预后的预测

Lactate clearance rate in different time points to predict the short-term prognosis of patients with mild hypothermia cerebral resuscitation

目的探讨早期血乳酸清除率对亚低温脑复苏患者短期预后的预测价值。方法采用Utstein模式收集48例脑复苏患者的基础资料、不同时间点的血乳酸及各项实验室指标,计算6、12、24 h乳酸清除率,并进行Glasgowpittsburgh（GCSP）评分。根据患者7 d预后情况,分成存活≤7 d组和存活〉7 d组,并对各指标进行分析。结果住院期间存活≤7 d组共22例,存活〉7 d组共26例。存活〉7 d组患者6、12、24 h乳酸清除率、GCSP评分、p H值、中心静脉血氧饱和度（Scv O2）较高,基础血乳酸水平、NT-pro BNP、碱剩余（BE）则较低。Logistic回归分析显示6 h乳酸清除率、Scv O2是预测亚低温脑复苏患者预后的独立危险因素,OR值分别为1.419、1.229。根据基础血乳酸水平及不同时间点乳酸清除率绘制ROC曲线,结果显示：6 h乳酸清除率的曲线下面积（AUC）为0.923（95%CI 0.809-0.980,P〈0.000 1）,最佳截值为15.00%,灵敏度为80.77%,特异度为90.91%;12 h乳酸清除率的AUC为0.745（95%CI 0.598-0.860,P〈0.05）,最佳截值为36.84%,灵敏度为76.92%,特异度为72.73%。6 h和12 h乳酸清除率AUC比较差异有统计学意义（Z=2.258,P=0.024）。结论 6 h血乳酸清除率是预测亚低温脑复苏患者短期预后的重要独立危险因素,截值〉15%可作为短期预后有利的预测指标。

Objective To investigate the early blood lactate clearance on the predictive value of short-term prognosis of patients with mild hypothermia cerebral resuscitation. Methods The data of 48 patients with cerebral resuscitation were collected and analyzed by adopted the Utstein mode,including the basis data, the different time points of blood lactate, and the laboratory indexes, calculation of 6 h, 12 h, 24 h lactate clearance rate, and Glasgow-Pittsburgh score. According to the prognosis of 7 days, 48 cases were divided into survival ≤7 d groups and survival 〉7 d group, and all the indexes were analyzed. Results In hospitalized patients, total of 22 cases for survival≤7 d groups, 26 cases for survival 〉7 d group. 6 h,12 h and 24 h lactate clearance rates, Glasgow-Pittsburgh score, p H, central venous blood oxygen saturation（Scv O2） were higher in the survival 〉7 d group of patients than those in survival ≤7 d group. But the basis of blood lactate level, NTpro BNP and base excess（BE） were lower in the survival 7 d group of patients. Logistic regression analysis showed that 6 h lactate clearance rate, Scv O2 were the independent risk factors for predicting the prognosis of patients with mild hypothermia cerebral resuscitation, the odds ratios were 1.419 and 1.229, respectively. According to the basis of blood lactate level and the different time points of lactate clearance rate, ROC curve drawing, the results showed that 6 h lactate clearance rate of the area under the curve was 0.923（95% CI, 0.809 to 0.980, P〈0.000 1）, with the best cutoff value of 15.00%, sensitivity of80.77%, and specific degree of 90.91%. 12 h lactate clearance rate of the area under the ROC curve was 0.745（95% CI, 0.598 to 0.860, P〈0.05）, with the best cutoff value of 36.84%, sensitivity of 76.92%, and specific degree of 72.73%. 6 h and 12 h lactate clearance rates of AUC were significantly different（Z=2.258, P=0.024）. Conclusion 6 h blood lactate clearance is important independent risk factor to predict the short-term prognosis of patients with mild hypothermia cerebral resuscitation,and Cutoff value 〉15% can be used as a favorable predictor of short-term prognosis.