乳酸清除率联合剩余碱评估失血性低血容量休克患者预后的价值分析

Clinical significance of lactate clearance and base excess on prognosis in patients with hemorrhagic hypovolemic shock

目的探讨联合监测乳酸清除率与剩余碱(BE)对失血性低血容量休克患者预后的评估价值。方法选取2013年1月至2016年1月该院收治的失血性低血容量休克患者115例,记录患者预后、入院时血乳酸、BE、APACHEⅡ评分、治疗后6h的血乳酸、BE及乳酸清除率。按照预后分为存活组94例和死亡组21例;按照患者乳酸清除率水平(以10%为界)分为高清除率组92例,低清除率组23例;按照BE水平(以-8mmol/L为界),分为高BE组96例,低BE组19例。比较各组参数间的不同。结果存活组患者入院时乳酸、APACHEⅡ评分及治疗6h后的乳酸均明显低于死亡组,而BE及治疗6h后的乳酸清除率明显高于死亡组;高清除率组入院时APACHEⅡ评分、病死率明显低于低清除率组,而BE则明显高于后者;高BE组入院时APACHEⅡ评分、病死率低于低BE组,而乳酸清除率高于低BE组,以上差异均有统计学意义(P<0.05)。病死率与BE、治疗6h后的乳酸清除率呈负相关(r分别为-0.765、-0.705,P<0.05),与APACHEⅡ评分呈正相关(r=0.652,P<0.05)。结论乳酸清除率联合BE检测对评估失血性低血容量休克患者的预后有重要意义。

Objective To evaluate the values of lactate clearance and base excess （BE） in assessment of prognosis in patients with hemorrhagic hypovolemic shock.Methods The data of 115 patients with hemorrhagic hypovolemic shock of the Meizhou people′s hospital from January 2013 to January 2016 were collected.The prognosis,APACHEⅡ scores,the lactic acid,the value of BE were monitored.After 6 hours the lactic acid,the value of BE were re-detected,the lactate clearance was calculated.According to the outcomes of disease,the patients were divided into the survival group（n=94） and the death group（n=21）.According the lactate clearance rate （10%）,the patients were divided into the high lactate clearance group（n=92） and the low lactate clearance group（n=23）.According the value of BE（-8 mmol/L）,the patients were divided into the high BE group（n=96） and low BE group（n=19）.The differences among the groups were compared respectively.Results In the survival group,the lactic acid,APACHE Ⅱ score were significantly lower than those of the death group（P〈0.05） when the patients were admitted to hospital and 6 h after treatment,but the value of BE and the lactate clearance was significantly higher（P〈0.05）.In the high lactate clearance group,APACHE Ⅱ score and the mortality rate were significantly lower than that of the low lactate clearance group,but the value of BE was significantly higher（P〈0.05）.In the high BE group,APACHE Ⅱ score and mortality rate were significantly lower than the low BE group,but the lactate clearance was significantly higher（P〈0.05）.All above differences were statistically significant（P〈0.05）.The mortality was negatively correlated with the value of BE and the acid clearance（r=-0.765 and-0.705,P〈0.05）,and was positively correlated with APACHE Ⅱ score（r=0.652,P〈0.05）.Conclusion The patients with the high lactate clearance group and the high BE group have better prognosis.The lactate clearance combined with BE have important significance in evaluating the prognosis of patients with hemorrhagic shock.