乳酸清除率对感染性创面导致脓毒性休克患者疗效与生存状况的评估价值

Value of clearance rate of lactic acid in evaluation of curative effect and survival condition of patients with septic shock induced by infectious wounds

目的探讨乳酸清除率对感染性创面导致脓毒性休克患者疗效与生存状况的评估价值。方法选取2015年1月-2016年1月在医院住院治疗的感染性创面导致脓毒性休克患者64例,在治疗30d后,根据患者是否发生多器官功能障碍综合征(MODS)将患者分为MODS组和非MODS组,并根据患者的生存状况分为死亡组和存活组,比较两组患者的乳酸水平以及乳酸清除率;并根据所有患者的乳酸清除率的高低将患者分为高乳酸清除率组和低乳酸清除率组,比较两组患者MODS和死亡发生率,确定乳酸清除率与感染性创面导致脓毒性休克患者MODS发生率、生存率的相关性,并对感染病原菌进行鉴定和分析。结果存活组22例,死亡组42例,存活组复苏24h后乳酸水平显著低于死亡组,存活组乳酸清除率显著高于死亡组,差异均有统计学意义;MODS组27例,非MODS组37例,非MODS组复苏24h后乳酸水平显著低于MODS组,非MODS组乳酸清除率显著高于MODS组,差异均有统计学意义;高乳酸清除率组的病死率和MODS发生率均显著低于低乳酸清除率组,差异有统计学意义;复苏24h后乳酸水平与MODS发生率和病死率具有显著正相关,乳酸清除率与MODS发生率和病死率具有显著负相关;感染患者60例共分离培养出81株病原菌,以革兰阴性菌为主47株占58.0%,主要包括铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌,革兰阳性菌32株占39.5%,主要包括溶血葡萄球菌、金黄色葡萄球菌、粪肠球菌,真菌2株占2.5%。结论乳酸清除率可以帮助评估感染性创面导致的脓毒性休克患者的疗效和生存状况;对于乳酸清除率较低的患者一定要及时给予合理的干预措施,在治疗感染的过程中要合理使用抗菌药物,有效提升感染性创面导致的脓毒性休克患者的预后。

OBJECTIVE To explore the value of clearance rate of lactic acid in evaluation of curative effect and survival condition of patients with septic shock induced by infectious wounds.METHODS A total of 64 patients with septic shock included by infectious wounds who were hospitalized for treatment from Jan 2015 to Jan 2016 were enrolled in the study and were divided into the MODS group and the non-MODS group after the treatment for 30 days according to the status of occurrence of multiple organ dysfunction syndrome（MODS）and into the death group and the survival group according to the survival condition.The lactic acid level and clearance rate of lactic acid were compared between the two groups of patients.All of the enrolled patients were divided into the high lactic acid clearance rate group and the low lactic acid clearance rate group according to the clearance rate of lactic acid,the incidence of MODS and mortality rate were compared between the two groups of patients,the association between the clearance rate of lactic acid and the incidence of MODS and mortality rate of the patients with septic shock induced by infectious wounds was determined,and the pathogens causing infection were identified.RESULTS There were 22 patients in the survival group and 42 patients in the death group;the lactic acid level of the survival group was significantly lower than that of the death group after the resuscitation for 24 hours,the clearance rate of lactic acid of the survival group was significantly higher than that of the death group.There were 27 patients in the MODS group and 37 patients in the non-MODS group,the lactic acid level of the non-MODS group was significantly lower than that of the MODS group,the clearance rate of lactic acid of the non-MODS group was significantly higher than that of the MODS group.The mortality rate and incidence of MODS were remarkably lower in the high lactic acid clearance rate group than in the low lactic acid clearance rate group.The lactic acid level showed significant positive correlation with the incidence of MODS and the mortality rate,while the clearance rate of lactic acid showed significant negative correlation with the incidence of MODS and the mortality rate.Totally 81 strains of pathogens were isolated from 60 patients with infection,including 47（58.0%）strains of gram-negative bacteria,32（39.5%）strains of gram-positive bacteria,and 2（2.5%）strains of fungi;Pseudomonas aeruginosa,Escherichia coli,Klebsiella pneumoniae,and Acinetobacter baumannii were the major species of gram-negative bacteria;Staphylococcus haemolyticus,Staphylococcus aureus,and Enterococcus faecalis were dominant among the gram-positive bacteria.CONCLUSIONThe clearance rate of lactic acid may facilitate the evaluation of therapeutic effect and survival condition of the patients with septic shock induced by infectious wounds.It is necessary to take reasonable intervention measures for the patients with low clearance rate of lactic acid in a timely manner and reasonably use antibiotics during the treatment of infection so as to effectively improve the prognosis of the patients with septic shock induced by infectious wounds.