血清降钙素原和早期乳酸清除率评估脓毒症患者预后的临床分析

Clinical analysis of serum procalcitonin and early lactate clearance rate in the prognostic evaluation in patients with sepsis

目的通过监测脓毒症患者血清PCT及动脉血乳酸水平的变化,探讨PCT及乳酸清除率在评价脓毒症患者严重程度及预后判断中的临床价值。方法选取本院ICU脓毒症患者60例。根据病情转归可分为存活组48例,死亡组12例;根据患者乳酸清除率水平(以10%为界)分为高乳酸清除率组39例,低乳酸清除率组21例。当患者确诊为脓毒症后留取静脉血10ml,离心取血清监测PCT水平;确诊为脓毒症后抽取2ml动脉血测定乳酸水平,治疗6h后再次抽取2ml动脉血测定乳酸水平,计算早期乳酸清除率,并对患者确诊当天进行急性生理学和慢性健康状况评分Ⅱ(APACHEⅡ)评分。结果死亡组在性别组成、年龄及APACHEⅡ评分之间与存活组比较差异无统计学意义(P>0.05)。死亡组血清PCT水平、动脉初始血乳酸水平及脓毒症休克的发生例数均较存活组明显增高(P<0.01);死亡组6h乳酸清除率较存活组明显降低(P<0.01)。高乳酸清除率组在性别组成、年龄、动脉初始血乳酸水平、血清PCT水平及APACHEⅡ评分之间与低乳酸清除率组比较差异无统计学意义(P>0.05)。高乳酸清除率组脓毒症休克的发生例数及病死率均较低乳酸清除率组明显减少(P<0.01)。结论 PCT能反应脓毒症患者病情的严重程度,有利于对患者预后的判断;早期乳酸清除率可以作为一个评价临床治疗疗效和预测预后的敏感指标。

Objective To explore the PCT and lactate clearance rate in the severity and prognosis evaluation of clinical value in patients with sepsis by monitoring changes serum PCT levels and arterial blood lactate. Methods Chosed 60 patients with sepsis in our hospital. The patients were divided into survival group（48 cases） and death group（12 cases） according to the disease outcome, and divided into high lactate clearance rate group （39 cases） and low lactate clearance rate group （21 cases） according to lactate clearance rate （with 10%for the sector）. Took 10ml venous blood after patients were diagnosed with sepsis, centrifugal, stored serum and monitored the level of serum PCT. Took 2ml arterial blood after patients were diagnosed with sep-sis and monitored the level lactate. Taken 2ml arterial blood again and monitored the level lactate after 6 hours treatment , cal-culated early lactate clearance rate, and done statistics acute physiology and chronic day health evaluation II （APACHEII） score. Results The gender composition age and APACHEII score showed no significant difference between the death group and survival groups （P〉0.05）. The serum PCT levels, arterial blood lactate levels and the number of septic shock cases in the death group was significantly higher than the survival group （P〈0.01）; 6h lactate clearance rate in death group was significantly lower than the survival group （P〈0.01）. The gender composition, age, initial arterial blood lactate levels, serum PCT levels and APACHEII scores showed no significant difference between high lactate clearance rate group and low lactate clearance rate group （P〉0.05）. The cases of patients with septic shock and mortality in high lactate clearance rate group were significantly re-duced than low lactate clearance rate group （P〈0.01）. Conclusion PCT can reflect the severity of patients with sepsis, it is beneficial for the patients prognosis. Early lactate clearance rate can be evaluated as a sensitive indicator for clinical efficacy and prognostic.