老年重症脓毒血症预后评估方法研究

Prognostic assessment in old patients with severe sepsis

目的探讨早期动脉血乳酸清除率和中心静脉血氧饱和度在老年重症脓毒血症患者预后评估中的临床价值。方法选择46例因重症脓毒症入住ICU的老年患者,按照28 d预后分为生存组和死亡组,其中生存组32例,死亡组14例。收集入院后或明确诊断重症脓毒症当时和6 h动脉血,测定血乳酸,于抽血后2 h内完成,并计算血乳酸清除率。同时留置中心静导管监测中心静脉血氧饱和度(Scv O2),建立急性生理与慢性健康状况(APACHEⅡ)评分。比较2组动脉血乳酸清除率、Scv O2和APACHEⅡ评分,并建立ROC曲线。结果 2组患者乳酸清除率、Scv O2和APACHEⅡ评分差异均有统计学意义(P<0.05或0.01),乳酸清除率、Scv O2与APACHEⅡ评分存在明显正相关(r=0.932,P=0.012)。乳酸清除率和Scv O2越低,APACHEⅡ评分越高,28 d病死率越高。乳酸清除率和Scv O2与APACHEⅡ评分的ROC曲线下面积分别为0.744、0.702、0.759。结论早期动脉血乳酸清除率和Scv O2与APACHEⅡ评分显著相关,可以预测老年重症脓毒症患者的预后,指导早期目标导向治疗。

Objective To investigate the value of early arterial blood lactic acid clearance and central venous oxygen satu- ration in the prognosis of old patients with severe sepsis. Methods Forty-six patients with severe sepsis were divided into survival group（ 32 cases） and death group（ 14 patients） according to their outcome. The arterial blood of the patients was prepared at the admission or diagnosis, and six hour later, the levels of blood lactic acid were tested. Blood lactate clear- ance rate was calculated. The central venous catheter was indwelled to test ScvO2 and carried out the acute physiology and chronic health evaluation（APACHE Ⅱ ）. The levels of blood lactic acid clearance, ScvO2 and APACHE Ⅱ between the two groups were compared. The curve of ROC was constructed. Results There were significant differences in the levels of blood lactic acid clearance, ScvO2 and APACHE Ⅱ score between the two groups. Blood lactic acid clearance and ScvO2 were significantly correlated with APACHE Ⅱ score. The lower Blood lactic acid clearance and ScvO2 the higher APACHE Ⅱ score, and the higher 28 d mortality was. The area under the curve （ AUC ） in ROC of blood lactic acid clearance, ScvO2 and APACHE Ⅱ score were 0. 744 ,0. 702 and O. 759. Conclusion The early arterial blood lactic acid clearance and ScvO2 are correlated with APACHE Ⅱ , and can be used for prognosis of old patients with severe sepsis, and guiding early treatment.