动态监测动脉血乳酸浓度联合早期血乳酸清除率对感染性休克患者预后的评估价值

Estimated Value of Dynamic Detection of Arterial Blood Lactic Acid Concentration Combined with Early Blood Lactic Acid Clearance Rate for the Prognosis of Septic Shock

目的:研究分析动态监测动脉血乳酸浓度联合早期血乳酸清除率对感染性休克患者预后的评估价值。方法:选取本院2014年1月-2017年6月期间收治的92例感染性休克患者为研究对象,根据患者预后情况,将其分为存活组(n=61)和死亡组(n=31)。测定两组患者入院时和治疗后6、12、24、48 h的动脉血乳酸水平,分析其变化趋势,并进行对比;详细记录患者入院时的健康状况,并采用APACHEⅡ进行评分,比较两组患者得分。结果:入院时,死亡组平均动脉血乳酸浓度为(5.37±2.75)mmol/L,存活组为(3.84±1.72)mmol/L,比较差异有统计学意义(t=5.671,P=0.021);存活组APACHEⅡ评分为(15.91±7.98)分,死亡组为(20.38±8.67)分,比较差异有统计学意义(t=17.314,P=0.003)。治疗后,存活组平均动脉血乳酸水平呈下降趋势,在治疗24 h后,平均血乳酸浓度降低为(1.53±0.98)mmol/L,不断趋于稳定;而死亡组平均动脉血乳酸水平呈上升趋势,在治疗48 h后上升到(7.95±3.09)mmol/L,与存活组相比,差异均有统计学意义(P<0.05)。治疗6 h后,存活组平均血乳酸清除率为(28.98±5.79)%,死亡组为(7.99±2.45)%,比较差异有统计学意义(t=21.312,P=0.001)。结论:动态监测动脉血乳酸水平联合早期血乳酸清除率,可以准确地反映感染性休克患者病情,指示患者预后,能够为感染性休克患者诊断、治疗提供借鉴依据。

Objective：To study and analyse the estimated value of dynamic detection of arterial blood lactic acid concentration combined with early blood lactic acid clearance rate for the prognosis of septic shock.Method：A total of 92 cases of septic shock treated from January 2014 to June 2017 in our hospital were selected as study objects.According to the patients＇ prognosis,they were divided into survival group（n=61） and death group（n=31）.The arterial blood lactic acid levels at admission and 6,12,24,48 h after treatment were measured and the change trend was analyzed and compared between the two groups.The health status of the patients at admission were recorded in detail,acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） was used to evaluate the scores of the two groups.Result：At admission,the arterial blood lactic acid concentration in the death group was（5.37±2.75） mmol/L,and in the survival group was（3.84±1.72） mmol/L,the difference was statistically significant（t=5.671,P=0.021）;the APACHE Ⅱ score in the survival group was（15.91±7.98）,and in the death group was（20.38±8.67）,the difference was statistically significant（t=17.314,P=0.003）.After treatment,the levels of arterial blood lactic acid in the survival group showed a downward trend.After 24 h of treatment,the blood lactic acid concentration in the survival group decreased to（1.53±0.98） mmol/L,which tended to be stable.But the level of arterial blood lactic acid in death group was on the rise.After 48 h of treatment,the arterial blood lactic acid concentration in death group increased to（7.95±3.09） mmol/L,compared with the survival group,the difference was statistically significant（P〈0.05）.After treatment 6 h,the lactic acid clearance rate in the survival group was（28.98±5.79）%,and in the death group was（7.99±2.45）%,the difference was statistically significant（t=21.312,P=0.001）. Conclusion：The dynamic detection of arterial blood lactate level combined with early blood lactic acid clearance rate can accurately reflect the condition of patients with septic shock and play an instructive role in the prognosis.It can provide references for the diagnosis and treatment of septic shock.