早期乳酸清除率在AECOPD并呼吸衰竭患者预后评估中的作用

The Role of Early Lactate Clearance Rate in Assessment of the Prognosis of Patients with AECOPD Combined with Respiratory Failure

目的探讨早期血乳酸清除率(LCR)在慢性阻塞性肺疾病急性加重期(AECOPD)并呼吸衰竭患者预后评估中的作用。方法将2011年10月至2014年1月在鄂州市中心医院ICU住院治疗的104例AECOPD并呼吸衰竭患者根据动脉血乳酸恢复正常时间分为24 h恢复组(48例)、48 h恢复组(14例)、72 h恢复组(13例)及72 h未恢复组(29例),根据患者预后分为存活组(64例)和死亡组(40例),根据患者12 h LCR分为高LCR组(>10%,77例)和低LCR组(≤10%,27例)。比较各组动脉血乳酸、p H值、动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)、Pa O2/氧合指数(Fi O2)、急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分等方面的差异。结果 24 h恢复组患者初始乳酸值、病死率明显低于72 h未恢复组[(3.3±0.9)mmol/L比(4.9±1.4)mmol/L,6.2%(3/48)比53.8%(7/13)](P<0.05),Pa O2/Fi O2明显高于72 h未恢复组[(155±54)比(119±33)](P<0.05)。存活组患者12 h LCR、初始p H值、初始Pa O2/Fi O2均明显高于死亡组[(44±13)%比(12±3)%,(7.38±0.13)比(7.30±0.14),(155±54)比(116±38)],而初始乳酸值、初始APACHEⅡ评分明显低于死亡组[(3.5±1.4)mmol/L比(4.8±1.5)mmol/L;(22±6)分比(26±5)分],差异均有统计学意义(P<0.05)。低LCR组患者治疗后血乳酸表达水平、病死率、APACHEⅡ评分均明显高于高LCR组[(5.5±1.3)mmol/L比(1.9±0.7)mmol/L,70.4%(19/27)比27.3%(21/77),(26±6)分比(21±5)分],而p H值明显低于高LCR组[(7.33±0.16)比(7.44±0.12)],差异均有统计学意义(P<0.05)。结论早期LCR对AECOPD并呼吸衰竭患者病情严重程度和预后评估具有重要的作用。

Objective To study the role of early lactate clearance rate（LCR） in assessment of the prog- nosis of patients with acute exacerbation of chronic obstructive pulmonary diseases（AECOPD） and respiratory failure. Methods Total of 104 patients with AECOPD and respiratory failure hospitalized in Department of ICU,Ezhou Center Hospital, from Oct. 2011 to Jan. 2014 were included, and divided into 24 h recovered group（48 eases） ,48 h recovered group（ 14 cases） ,72 h recovered group（ 13 eases） and 72 h unrecovered group（29 cases） according to the recovery time of arterial blood lactic acid, and were divided into survival group （64 cases ） and death group （40 cases ） according to the prognosis ;and were divided into the high lactic acid clearance（LCR） group（ 〉 10% ,77 cases）and the low LCR group（ ≤10% ,27 cases） according to the 12 h LCR. The arterial blood lactic acid, pH value, oxygen partial pressure in artery （PaO2）, partial pressure of carbon dioxide in artery（ PaCO2 ）,PaO2/oxygenation index（ FiO2 ） , acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ） score of different groups were compared. Results The initial lactic acid value and fatality of 24 h recovered group were less than that of 72 h unreeovered group [ （3.3 ± 0. 9 ） mmol/L vs （4. 9 ± 1.4） mmol/L,6. 2% （3/48） vs 53.8% （7/13） ] ,PaO2/FiO2 was significantly higher than that of 72 h unrecovered group [ （ 155 ± 54 ） vs （ 119 ± 33 ） ] （ P 〈 0. 05 ）. The 12 h LCR, initial pH value, initial PaO2/FiO2 of the survival group were significantly higher than that of the death group [ （44 ± 13 ） % vs （12 ±3）% ,（7.38 ±0. 13） vs （7. 30 ±0. 14） ,（155 ±54） vs （116±38） ] （P 〈0. 05） ,while the initial lactate and initial APACHE Ⅱ score were significantly lower than the death group [ （3.5 ± 1.4） mmol/L ：vs （4. 8 ± 1.5 ） mmol/L; （22 ± 6） scores vs （26± 5 ） scores ] （ P 〈 0. 05 ）. The blood lactic acid expression level,the case fatality rate, APACHE Ⅱ score of the low LCR group after treatment were significantly higher than that of the high LCR group [ （ 5.5 ± 1.3 ） mmol/L vs （ 1.9 ± 0. 7 ） mmol/L, 70. 4% （ 19/27 ） vs 27. 3% （21/77）, （26± 6 ） scores vs （21 ± 5 ） scores ] （P 〈 0. 05 ）,and the pH value was significantly lower than that of the high LCR group [ （7.33 ± 0. 16 ） vs （7.44 ± 0. 12） ] （ P 〈 0.05 ）. Conclusion The early LCR plays an important role in assessment of disease severity and prognosis of patients with AECOPD and respiratory failure.