早期乳酸清除率及APACHEⅡ评分对老年重症肺炎患者预后判断的研究

Prognostic value of APACHEⅡscore and early lactate clearance rate in the elderly severe pneumonia patients

目的:探讨早期乳酸清除率和急性生理学和慢性健康状况Ⅱ(APACHEⅡ)评分对老年重症肺炎患者预后的临床意义。方法:对重症医学科收治的47例老年重症肺炎患者,平均年龄(83.1±8.4)岁,分别于入院时和明确诊断后6 h测定动脉血乳酸,计算乳酸清除率。在患者入院第1个24 h内进行APACHEⅡ评分。以患者入院后28 d预后为研究终点,将患者分为存活组和死亡组,比较两组患者早期乳酸清除率及APACHEⅡ评分。根据明确诊断后6 h乳酸清除率将患者分为高乳酸清除率组(乳酸清除率≥10%)和低乳酸清除率组(乳酸清除率<10%),比较两组患者APACHEⅡ评分、机械通气率、病死率。采用受试者工作特征(ROC)曲线分析乳酸清除率预测老年重症肺炎患者预后的价值。结果:存活组和死亡组的乳酸清除率分别为(19.7±6.4)%和(7.7±10.1)%,差异有统计学意义(P<0.01);高乳酸清除率组和低乳酸清除率组28 d病死率分别为26.7%(8/30)和58.8%(10/17),高乳酸清除率组低于低乳酸清除率组(P<0.05);乳酸清除率预测老年重症肺炎患者28 d病死率最佳临界点为20%,敏感性68.9%,特异性67.9%。结论:早期乳酸清除率与APACHEⅡ评分正相关,两者可作为判断老年重症肺炎患者预后的指标。

Objective：To explore the clinical prognostic significance of early lactate clearance rate and APACHEⅡscore in elderly severe pneumonia patients. Methods：47 elderly severe pneumonia patients who were admitted into ICU were enrolled. The average age was （83. 1 ± 8. 4） years old. Their arterial blood lactate levels were tested at admission and 6 hours later for calculating early lactate clearance rate. The acute physiology and chronic health evaluationⅡ （ APACHE Ⅱ） score was evaluated in the first 24 hours. 28 days after admission was the end of research. Patients were divided into survival group and death group. Taking 10% as cut-off, patients were divided into high lactate clearance rate（≥10%） group and low lactate clearance rate（ 〈10%） group. Values of APACHEⅡscore and early lactate clearance rate to predict the prognosis of elderly severe pneumonia patients were determined by ROC curves. Results： Early lactate clearance rate was higher in survival group than that in death group[（19.7 ± 6. 4）% vs（7. 7 ± 10. 1）%,P 〈0. 01]. Mortality of high lactate clearance rate group was decreased as compared with low lactate clearance rate group [ （ 26 . 7%（ 8/30 ） vs 58 . 8%（ 10/17 ） , P 〈0 . 05 ] . The thresholds of early lactate clearance rate to predict mortality of elderly severe pneumonia patients were 20 . 0%（ sensitivity 68 . 9%, specificity 67 . 9%） . Conclusions： There is a positive correlation between early lactate clearance rate and APACHE Ⅱ score, which are meaningful predictors for prognosis of elderly severe pneumonia patients.