乳酸动态监测指标对重症患者预后评估的价值

The significance of lactic dynamic indicators for the assessment of the prognosis of critically illed patients in intensive care unit

目的探讨乳酸动态监测指标对重症监护病房（ICU）危重患者预后评估的价值。方法回顾性分析解放军第二五一医院85例ICU收治的血乳酸升高的危重患者的临床资料，按照临床预后、乳酸峰值、乳酸清除率的高低分为不同的组别，应用logistic回归方法分析与预后显著相关的指标，并分析不同的乳酸水平、乳酸清除率对患者死亡、休克、多器官功能障碍综合征（MODS）等的影响。结果死亡组40例，存活组45例；死亡组入ICU乳酸值、乳酸峰值高于存活组，6h、12h和24h乳酸清除率均低于存活组（P均〈0．05）。多元逐步logistic回归分析，影响乳酸升高患者预后的主要乳酸指标是12h乳酸清除率（OR=0．864，95％CI：0．802～0．915，P〈0．05）和乳酸峰值（OR=1．526，95％凹：1．043-2．030，P〈0．05）。乳酸酸中毒组（28例）与高乳酸血症组（28例）比较，前者MODS发生率（64．3％VS．29．6％，P〈0．05）和住院病死率（46．4％vs．18．5％，P〈0．05）均明显高于后者；严重乳酸酸中毒组（30例）与乳酸酸中毒组比较，前者的休克发生率（83．3％vs．60．7％，P〈0．05）、MODS发生率（86．7％vs．64．3％，P〈0．05）及住院病死率（76．7％VS．46．4％，P〈0．05）较后者明显升高。12h乳酸低清除率组的病死率显著高于高清除率组（67．9％vs．40．4％，P〈0．05）。结论乳酸峰值、12h乳酸清除率是评价患者预后的良好指标。乳酸峰值≥10mmol／L、12h乳酸清除率≤10％时，提示患者预后较差。

Objective To study the value of lactic dynamic indicators for the prognosis of critically illed patients in intensive care unit（ICU）. Methods The data of 85 critically illed patients were divided into the survival group（n=45） and the death group（n=40） according to the prognosis. The influence of different lactate levels,lactate clearance rate on the death, shock, multiple organ dysfunction（MODS） were analyzed. Results The lactate level when patients were admitted to ICU and the peak level of lactate of the death group were significantly higher than that of the survival group, and the lactate clearance rate of death group at 6, 12 and 24 h were significantly lower than those of the survival group （P 〈 0.05）. Logistic regression analysis showed that the key indicators that would impact the prognosis of patients were lactate clear- ance rate （OR=0.864, 95% CI：0.802-0.915, P 〈 0.05） at 12 h and the peak lactate level（OR=1.526, 95% CI：1.043-2.030, P 〈 0.05）. The incidence of death, shock, multiple organ dysfunction, increased with increasing degree of lactic acidosis （P 〈 0.05）. Conclusion Peak lactate level, the 12 h lactate clearance rate are effective indicators to evaluate the prognosis of critically ill patients. When the lactate peak level≥ 10 mmol/L and 12 h lactate clearance rate≤ 10%, the patients usually have poor prognosis.