早期监测动脉血乳酸清除率和中心静脉血氧饱和度对危重病患者预后的影响

MONITORING OF ARTERIAL BLOOD LACTIC ACID CLEARANCE RATE AND CENTRAL VENOUS BLOOD OXYGEN SATURATION ON PROGNOSIS OF CRITICAL PATIENTS

目的：探讨早期监测动脉血乳酸清除率和中心静脉血氧饱和度（central venous oxygen saturation， ScVO2）对危重病患者预后的影响。方法189例 ICU 住院的危重病患者根据急性生理学与慢性健康状况评分Ⅱ（Acute Physiology and Chronic Health Evaluation，APACHEⅡ）分为评分＞30分组（A 组），＞20～30分组（B 组），＞10～20分组（C 组），0～10分组（D 组），比较4组早期（6h）血乳酸清除率、ScVO2、病死率等指标。患者均经过常规治疗及专科处理。治疗28d 后根据患者是否存活分为死亡组（61例）和存活组（128例），分析死亡组和存活组APACHEⅡ、早期血乳酸清除率、ScVO2等指标，并加以比较。分别对危重病患者 APACHEⅡ与早期血乳酸清除率、ScVO2的相关性加以分析。结果不同 APACHEⅡ评分组的血乳酸清除率、ScVO2、病死率差异有统计学意义（P ＜0．05）；死亡组 APACHEⅡ显著高于存活组（P ＜0．01），6h 乳酸清除率和 ScVO2显著低于存活组（P ＜0．01）；APACHEⅡ与6h 乳酸清除率呈负相关（r ＝－0．618，P ＜0．05），与 ScVO2呈负相关（r ＝－0．695，P ＜0．05）。结论ScVO2和6h 血乳酸清除率与危重病患者严重程度呈负相关，并能通过 ScVO2和早期血乳酸清除率反映患者预后和转归情况，值得临床进一步推广和研究。

Objective The early monitoring in arterial blood lactic acid clearance rate and central venous blood oxygen saturation （ScVO2 ） on the prognosis of critical patients were discussed.Methods A total of 189 ICU critical patients treated in our hospital were divided into four groups according to Acute Physiology and Chronic Health Evaluation （APACHE Ⅱ ）：patients greater than 〉 30 belonged to group A;ranged from 〉 20 - 30 belonged to group B;ranged from 〉10-20 belonged to group C;and ranged from 0-10 belonged to group D.Then, the blood lactate clearance rate,ScVO2 ,mortality were compared among the four groups in their early treatment.All the patients received conventional treatment and professional care and after 28 days of treatment,and they were divided into death group （61 patients）and survival group（128 patients）according to whether survive or not.And then,the members in both groups were tested by APACHE Ⅱ grade,along with the measurement of early blood lactate clearance rate andScVO2 .All the data were mortality and their relativity studied.Results Blood lactate clearance rate,and ScVO2 ,mortality in various APACHE Ⅱgroups were significantly different （P 〈0.05）;APACHE Ⅱ grade in death group was significantly higher than that in survival group （P 〈0.01）;lactate clearance rate tested 6 hours after treatment in death group was lower than that in survival group （P 〈 0.01）;ScVO2 in death group was significantly lower than that in survival group （P 〈0.01）;Through correlation analysis,APACHE Ⅱ score and lactate clearance tested 6 hours of treatment were negatively correlated （r =-0.618,P 〈0.05）,while APACHE Ⅱ score had significant positive correlation with ScVO2 （r = -0.695,P 〈 0.05）.Conclusion ScVO 2 and blood lactate clearance rate have much to do with the severity of the disease,and definitely,the prognosis and recovery can be reflected by ScVO2 and early blood lactate clearance rate deserves recommendation to clinical use and research.