血乳酸动态检测及APACHEⅡ评分对脓毒症预后的评估价值

Evaluation value of blood lactic acid dynamic monitoring and APACHE Ⅱ score in prognosis of sepsis

目的探讨血乳酸动态检测及急性生理和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分对脓毒症患者预后的评估价值。方法 2015年1-10月该院重症医学科(ICU)病房收治的脓毒症患者76例,对其血乳酸水平、乳酸清除率、休克、多器官功能障碍综合征(MODS)发病率及病死率等指标进行统计分析,并对各变量与预后进行多因素Logistic回归分析。结果乳酸升高组患者的APACHEⅡ评分、休克、MODS发病率及病死率明显高于乳酸正常组,差异有统计学意义(P<0.05)。按乳酸峰值分组中,3组各观察指标比较均差异无统计学意义(P>0.05);按6h乳酸清除率分组中,高清除率组除外APACHEⅡ评分,其余观察指标均明显低于低清除率组,差异有统计学意义(P<0.05)。存活组入院乳酸、乳酸峰值、6h乳酸清除率、APACHEⅡ评分指标均明显优于死亡组,差异有统计学意义(P<0.05)。按APACHEⅡ评分3组比较,乳酸峰值、休克、MODS发病率及病死率均存在差异(P<0.05)。入院乳酸水平、6h乳酸清除率及APACHEⅡ评分为脓毒症患者预后的独立危险因素。结论入院乳酸水平、6h乳酸清除率及APACHEⅡ评分为脓毒症患者预后的独立危险因素。

Objective To investigate the evaluation value of blood lactic acid dynamic monitoring and APACHE Ⅱ score in trhe prognosis of sepsis.Methods The blood lactic acid level,lactic acid clearance rate,shock and MODS occurrence rate and mortality in 76 patients with sepsis in ICU of our hospital from January to October 2015 were statistically analyzed.Various indexes and prognosis were performed the multi-variable Logistic regression analysis.Results The APACHEⅡ scores,shock and MODS occurrence rate and mortality in the lactic acid elevation group were higher than those in the lactic acid normal group,the difference was statistically significant（P0.05）.In grouping according to the lactic acid peak value,the observation indexes had no statistical difference among 3groups（P0.05）;in grouping according to 6hlactic acid clearance rate,except APACHEⅡscore,the other observation indexes in the high clearance rate group were significantly lower than those in the low clearance rate group,the difference was statistically significant（P0.05）.The lactic acid level at admission,lactic acid peak value,6hlactic acid clearance rate and APACHEⅡscore in the survival group were significantly better than those in the death group,the difference was statistically significant（P0.05）.In 3groups according to APACHEⅡ score,the lactic acid peak value,shock,MODS occurrence rate and mortality rate had statistically significant differences among 3groups（P0.05）.The lactic acid level at admission,6hlactic acid clearance rate and APACHEⅡscore were the independent risk factors in the patients with sepsis.Conclusion The lactic acid level at admission,6hlactic acid clearance rate and APACHEⅡ score were the independent risk factors in the patients with sepsis.