重症慢性阻塞性肺疾病患者APACHE Ⅱ评分及乳酸清除率水平与临床预后的关联分析

Correlation of APACHE Ⅱ score and lactate clearance rate with clinical prognosis in patients with chronic obstructive pulmonary disease

目的：研究重症慢性阻塞性肺疾病（COPD）患者入院12 h乳酸清除率、急性生理与慢性健康（APACHEⅡ）评分与患者预后的关系。方法：对本院重症监护病房收治的103例重症COPD患者的住院资料、预后情况进行统计分析,根据患者的入院24 h APACHEⅡ评分、12 h乳酸清除率进行分组,探讨APACHEⅡ评分、12 h乳酸清除率与患者预后的关系。结果：APACHEⅡ评分≤20分组的预后效果较好,其死亡率为8.33%,显著低于21~30分组的32.81%和≥31分组的73.33%（均P〈0.05）,21~30分组的死亡率显著低于≥31分组（P〈0.05）;治疗12 h后的Pa CO2、入住ICU时以及治疗12 h后的血乳酸水平、机械通气治疗时间APACHEⅡ评分≤20分组均显著低于21~30分组和≥31分组（均P〈0.05）。高清除率组死亡率为19.05%,显著低于低清除率组的42.62%（P〈0.05）;治疗12 h后的Pa CO2、入住ICU时及治疗12 h后的血乳酸水平、机械通气治疗时间高清除率组均显著低于低清除率组（均P〈0.05）,而Pa O2水平高清除率组显著高于低清除率组（P〈0.05）。结论：根据患者入住ICU 12 h的血乳酸清除率、24 h APACHEⅡ评分情况可以对重症COPD患者的预后情况进行预测,因此临床中应密切关注这两项指标,并及时调整治疗措施。

Objective： To analyze the correlation of APACHE score and lactate clearance rate with the prognosis in patients with severe chronic obstructive pulmonary disease（ COPD）. Methods： The clinical data and prognosis of 103 cases with severe COPD patients admitted to the intensive care unit of hospital were retrospectively and statistically analyzed. According to 24 h APACHE Ⅱ score,the patients were divided into group Ⅰ（ score≤20）,group Ⅱ（ 21 ~ 30 score） and group Ⅲ（ score≥30）,and divided into high lactate clearance and low clearance rate group in accordance with 12 h lactate clearance rate. Their relations with prognosis were studied. Results： In groupⅠ,the patients had better prognosis and the mortality rate（ 8. 33%） was significantly lower than that of the groupⅡ（ 32. 81%） and group Ⅲ（ 73. 33%）（ P〈0. 05）,and the mortality rate in group Ⅱ was significantly lower than that in group Ⅲ（ P〈0. 05）. The levels of Pa CO2 and blood lactate,and the mechanical ventilation time in groupⅠ 12 h after treatment were significantly lower than those in group Ⅱ and group Ⅲ（ P〈0. 05）. The mortality in high lactate clearance rate group（ 19. 05%） was significantly lower than that in low clearance rate group（ 42. 62%）（ P〈0. 05）. The levels of Pa CO2 and blood lactate,and the mechanical ventilation time in high clearance group were significantly lower and shorter than those in low clearance rate group（ P〈0. 05） 12 h after treatment.Conclusion： The prognosis of patients with severe COPD can be predicted according to the patients＇ 12 h blood lactate clearance rate and 24 h APACHE Ⅱ score. Thus,attention should be paid to the two indicators in the clinical treatment of the disease.