血乳酸清除率和D-二聚体联合检测判断老年重症肺炎患者转归分析

Elimination rate of blood lactic acid combined with D-dimer on clinical outcomes in elderly patients with severe pneumonia

目的 分析动态检测血乳酸及D-二聚体水平在预测老年重症肺炎患者转归中的应用价值。方法 选取老年重症肺炎患者94例作为研究对象,根据患者的转归分为存活组（63例）和死亡组（31例）,比较分析两组患者的动脉血乳酸、6 h内乳酸清除率及D-二聚体水平的变化、疾病评估预后系统（APACHEⅡ）评分。结果 存活组患者血乳酸水平在入院治疗12-24 h后迅速降低到正常水平,而死亡组患者血乳酸呈持续高水平状态;死亡组患者D-二聚体水平治疗72 h内无明显下降,明显高于存活组（P〈0.05）;APACHEⅡ评分与血乳酸浓度呈正相关（r=0.656,P〈0.05）。结论 动态监测老年重症肺炎患者的血乳酸及D-二聚体水平,可以评估疗效,判断预后,具有重要的临床应用价值。

Objective To investigate the prediction value of blood lactic acid combined with D-dimer on clinical outcomes in elderly patients with severe pneumonia. Methods A total of 94 cases of elderly patients with severe pneumonia were divided into survival group （63 cases ） and mortality group （31 cases ） according to clinical outcomes , the arterial blood lactate, lactate clearance rate within 6 h and D-dimer, prior disease prognosis assessment system （APACHE Ⅱ ） score between the two groups were compared. Results After 12 -24 hours of treatment, the level of blood lactic acid in survival group was decreased to the normal level, but it was keeping the high level in the mortality group; the level of D-dimer in mortality group had no obvious changes after treatment for 72h , which was significantly higher than that of survival group （ P 〈 0.05 ） ; there was a positive correlation between blood lactic acid and APACHE Ⅱ scores （r = 0. 656,P 〈 0.05 ）. Conclusions Dynamic monitor of blood lactic acid and D-dimer is benificial for the evaluation of efficacy and prognosis of severe pneumonia in elderly patients and has important clinical values.