血乳酸动态监测对脓毒血症预后评价的临床意义

The Clinical Significance of Dynamic Changes of Arterial Blood Lactic Acid on Patients with Sepsis

目的动态监测脓毒血症患者动脉血乳酸浓度,探讨血乳酸及其清除率对脓毒血症患者病情预后的判断价值。方法选择2011年2月~2014年6月收住我院ICU的74例脓毒血症患者,采用早期目标指导治疗（EGDT）,按患者的预后将脓毒血症伴有动脉血乳酸水平升高（≥2.0 mmo L/L）的患者根据是否存活分为死亡组（36例）和存活组（38例）,比较两组动脉血乳酸监测指标（动态乳酸水平、乳酸清除率）、急性生理和慢性健康状况Ⅱ评分及多脏器功能障碍综合征发生率。结果死亡组入ICU后0、6、24、48和72 h的动脉血乳酸水平、APACHEⅡ评分、多脏器功能障碍综合征发生率均显著高于存活组（P〈0.05）,早期目标导向治疗达标率明显低于存活组,差异均有统计学意义（P〈0.05）;存活组6、24 h乳酸清除率≥10%的比例明显高于死亡组,差异有统计学意义（P〈0.01）。多元Logistic回归分析显示24 h动脉血乳酸水平及6 h乳酸清除率是脓毒血症患者死亡的独立危险因素。结论脓毒血症患者动脉血乳酸浓度增高及6 h低乳酸清除率患者预后不良,动态监测动脉乳酸水平是判断脓毒血症患者预后和病情严重程度的一个良好指标。

Objective To observe the relationship between the dynamic changes of arterial blood lactic acid and patients＆#39; prognosis undergoing sepsis by testing the lactic acid level. Methods 74 patients illed with sepsis from January 2011 to June 2014 were treated by early goal-directed therapy （EGDT）. According to the prognosis of patients and elevated arterial blood lactic acid level （≥2.0mmoL/L） , they were divided into death group （n=36） and survival group （n=38） by prognosis. Differences in their lactic acid indexes （including dynamic lactated level, lactate clearance rate）, acute physiology and chronic health evaluationⅡ （APACHEⅡ）score, incidence of multiple organ dysfunction syndrome （MODS）were compared. Results For death group after they were transferred into ICU, 0, 6, 24, 48 and 72 h of arterial blood lactate level, the APACHEⅡscore, incidence of MODS of the death group were significantly higher than those the survival group （P〈0.05）;and compliance rate of EGDT of the death group was significantly lower than the survival group （P〈0.05）. The lactate clearance rate of 6-and 24-hour in survival group were significantly higher than that in death group （P＆lt;0.01）. When the lactate clearance rate was large than 10%in 6 hours, there would have a significantly lower mortality. By using a multivariate logistic regression analysis, it showed that the lactate value in 24 hours and the lactate clearance rate in 6 hours are the independent risk factors to fatality rate of patients undergoing sepsis. Conclusion Sepsis patients with high lactic acid blood concentration and a low 6-hour lactate clearance rate have an unfavorable prognosis. Dynamic monitoring of arterial lactate levels is a good indicator to determine the prognosis of patients with sepsis.