动态监测重症肺炎患者血乳酸、氧合指数及C反应蛋白的临床意义

Clinical significance of dynamic monitoring blood lactic acid, oxygenation index and CRP in patients with severe pneumonia

目的回顾性分析重症肺炎患者动态监测动脉血乳酸、氧合指数及C反应蛋白（CRP）的变化。方法34例重症肺炎患者中，26例存活（存活组），8例死亡（死亡组），分析比较两组动脉血乳酸、氧合指数及C反应蛋白的变化；结合急性生理学、年龄及既往疾病评估预后系统（APACHEⅡ）评分，分析其在疾病转归与预后的价值。结果存活组血乳酸水平明显低于死亡组，其血乳酸在入院治疗12～24h迅速降低到正常水平，而死亡组血乳酸呈持续高水平状态；存活组患者的氧合指数明显高于死亡组，且维持在正常水平，而死亡组氧合指数低于正常且持续下降。死亡组C反应蛋白72h内无明显下降，较存活组明显升高（P〈0．05）。APACHEⅡ评分与血乳酸浓度呈正相关（r=0．656，P〈0．05）。结论重症肺炎患者动态监测动脉血乳酸、氧合指数及C反应蛋白水平在评估疗效、判断预后中具有重要意义。

Objective To analyze the clinical significance of dynamic monitoring blood lactic acid, oxygenation index and C-reactive protein （CRP） in patients with severe pneumonia. Methods The clinical data of 34 patients with severe pneumonia were collected. According to clinical outcomes,the patients were divided into survival group （ n =26） and dead group （ n =8）. The blood lactic acid,oxygenation index, CRP and APACHE Ⅱ score were retrospectively analyzed in order to explore the clinical significance of these indexes for prognosis of the patients. Results There was no difference in age, sex, the initial concentrations of blood lactic acid, CRP and APACHE Ⅱ score at admission to ICU. However, blood lactic acid level decreased to the normal level within 12-24 hours after treatment in the survival group while it maintained higher level in the dead group even at 72nd hour after treatment. Oxygenation index in the survival group was significantly higher than that in the dead group. Moreover,oxygenation index was maintained in normal level in the survival group while it was below normal level and continued to decline. There was a positive correlation between blood lactic acid and APACHE Ⅱ score （ r = 0. 656, P〈 0.05）. Conclusions The dynamic monitoring levels of blood lactic acid, oxygenation index and CRP in patients with severe pneumonia can not only evaluate the therapeutic efficiency, but also estimate the prognosis for patients with severe pneumonia.