早期动脉血乳酸水平及乳酸清除率对慢性肝功能衰竭患者预后评估的价值

Predictive values of early blood lactate and lactate clearance on prognosis evaluation in patients with chronic liver failure

目的探讨早期动脉血乳酸水平及乳酸清除率对慢性肝功能衰竭患者预后的评估价值。方法对收住本科室的慢性肝功能衰竭患者进行临床观察研究,测定入院时(0小时)及入院后12小时动脉血乳酸水平,并对患者进行Child-Pugh评分,分析早期动脉血乳酸水平、乳酸清除率、Child-Pugh评分和患者28天病死率的关系。结果本次研究共纳入76例慢性肝功能衰竭患者,28天病死率为52.63%。死亡组患者0小时、12小时动脉血乳酸水平以及Child-Pugh评分均高于生存组(P值分别为0.00045、0.00033、0.0071);患者早期动脉血乳酸值与Child-Pugh评分呈正相关(P值分别为0.041、0.047);生存组患者12小时乳酸清除率显著高于死亡组(P=0.00024)。结论对于慢性肝功能衰竭患者,早期动态监测动脉血乳酸水平具有重要意义,可将0小时、12小时动脉血乳酸水平和12小时动脉血乳酸清除率作为评估慢性肝功能衰竭患者预后的依据。

Objective To investigate the predictive value of early blood lactate and lactate clearance on prognosis evaluation in patients with chronic liver failure. Methods The clinical data of patients with chronic liver failure in the Fifth Affiliated Hospital of Kunming Medical University were studied prospectively. The blood lactate levels at 0 h, 12 h and Child-Pugh score were measured respectively. The relationships between early blood lactate level, lactate clearance rate, Child-Pugh scores and the 28-day mortality were analyzed. Results Total of 76 patients with chronic liver failure were selected. The 28-day mortality was 52.63%. The blood lactate level in death group at 0 h, 12 h and Child-Pugh score were higher than those in survival group（P = 0.00045, 0.00033, 0.0071）. The correlation between early blood lactate and Child- Pugh score was significant（P = 0.041, 0.047）. The lactate clearance rate at 12 h in survival group was significantly higher than that of death group（P = 0.00024）. Multivariate logistic regression analysis showed that the blood lactate at 0 h, 12 h and the lactate clearance rate at 12 h were independent predictive factors of prognosis evaluation. Conclusions For patients with chronic liver failure, early dynamic monitoring arterial blood lactic level is of great significance. Blood lactate level at 0 h, 12 h and the lactate clearance rate at 12 h have practical clinical value for prognosis of patients with chronic liver failure.