早期乳酸清除率与心肺复苏ROSC后MODS预后的关系探讨

Clinical Analysis of a Correlation between Lactate Clearance and Prognosis in Patients with MODS Following Resuscitation

目的:探讨乳酸清除与心脏复苏自主循环恢复(ROSC)后多器官障碍综合征(MODS)患者预后的相关性。方法:我院心肺复苏ROSC后存活24h以上发生MODS的成年患者62例;分别在ROSC后3d、7d时将患者分为存活组和死亡组,分别比较两组患者的年龄、性别、APACHEⅡ评分、白细胞计数、平均动脉压、氧合指数、初始乳酸值及6h乳酸清除率之间的差异。结果:在ROSC后3d、7d时分别存活34例(54.8%)和21例(33.9%)。在ROSC后3d、7d时对上述指标进行单因素分析显示死亡组APACHEⅡ评分均明显高于存活组(P<0.05),死亡组6h乳酸清除率均明显低于存活组(P<0.05),其余指标比较差异均无统计学意义(P>0.05)。进一步多因素Logistic回归分析显示,APACHEⅡ评分和6h乳酸清除率在ROSC后3d时两组比较差异均无统计学意义(P>0.05);而在ROSC后7d时比较差异具有统计学意义(P<0.05)。结论:心搏骤停患者ROSC后早期乳酸清除率的降低与不良预后具有一定的相关性,并可能成为心搏骤停患者恢复期死亡的独立预测因子。

Objective： To investigate the lactate clearance and cardiac recovery of spontaneous circulation（ROSC） after multiple organ dysfunction syndrome（MODS） associated with the prognosis of patients. Methods： Our hospital CPR survived ROSC 62 adult patients with above 24 h MODS patients after ROSC, respectively; 3D 7d patients were divided into survival group and death group, we compared two groups of patients with age, sex, APACHE score, white blood cell count, mean arterial pressure, oxygen index, the initial value of 6h lactic acid and lactate clearance rate differences between. Results： After ROSC 3D, 7d respectively 34 cases survived（54.8%） and 21 cases（33.9%）. After ROSC 3D, 7d of the index of single factor analysis showed that the death group APACHE II score were significantly higher than the survival group（P〈0.05）, the death group 6h lactic acid clearance rate were significantly lower than the survival group（P〈0.05）, the other indexes were not significant（P〉0.05）. Further multivariate Logistic regression analysis showed that, APACHE score and 6h lactate clearance rate in ROSC after 3D of the difference between the two groups had no statistical significance（P〉0.05）; in ROSC 7d after the difference was statistically significant（P〈0.05）. Conclusion： In patients with cardiac arrest after ROSC of early lactate clearance rate decreased and correlated with poor prognosis, and may be independent predictors of death during recovery in patients with cardiac arrest.