血乳酸值和乳酸清除率对重症胡蜂蛰伤的预后价值

Predictive value of blood lactate level and its clearance rate in prognosis of severe wasp stings

目的探讨乳酸及乳酸清除率在重症胡蜂蛰伤预后中的预测价值。方法选择2012年7月—2017年7月入住我院急诊ICU的223例重症胡蜂蛰伤患者作为研究对象,根据其临床结局分为生存组(186例)和死亡组(37例),结合APACHEⅡ评分,采用Logistic回归分析重症胡蜂蜇伤患者预后的危险因素,采用Spearman法对乳酸、乳酸清除率与APACHEⅡ评分进行相关性分析,并绘制受试者工作特征(ROC)曲线,探讨其对判断重症胡蜂蜇伤患者预后的价值。结果生存组患者的入院时动脉血乳酸值、 24 h动脉血乳酸值和APACHEⅡ评分均明显低于死亡组,而生存组患者的24 h乳酸清除率显著高于死亡组,差异均具有统计学意义(P<0.05)。上述结果表明,乳酸水平、乳酸清除率和APACHEⅡ评分是影响重症胡蜂蛰伤患者预后的独立危险因素;重症蛰伤患者的血乳酸水平和APACHEⅡ评分之间呈正相关(r=0.824,P<0.01), 24 h乳酸清除率和APACHEⅡ评分之间呈负相关(r=-0.318,P<0.01);动脉血乳酸水平预测死亡的最佳临界值为15.1 mmol/L,敏感性为86%,特异性为63%; 24 h乳酸清除率预测死亡的最佳临界值为22.1%,敏感性为62%,特异性为83.3%。结论乳酸和乳酸清除率在重症胡蜂蛰伤病情判断、预后评估方面具有一定临床应用价值,且检测方便、简捷、经济,值得临床推广。

Objective To discuss the predictive value of arterial blood lactate level and its clearance in prognosis of severe wasp stings.Methods A total of 223 patients with severe wasp stings admitted to the emergency department ICU of our hospital from July 2012 to July 2017 were selected as research objects, and divided into survival group （186 cases） and death group （37 cases） according to their clinical outcomes. On the basis of APACHE Ⅱ score, Logistic regression was used to analyze the risk factors of influencing prognosis in critical wasps stings patients. Meanwhile, Spearman method was used to analyze the correlation among lactic acid, lactic clearance and APACHE Ⅱ score, and the work characteristics curve （ROC） ofthe subjects were plotted for comparing the value in predicting the prognosis of patients with severe wasps stings.Results Thearterial blood lactate values at admission, the arterial blood lactate values and APACHE Ⅱ scores of survival patients at 24 hafter admission were all significantly lower than that of the dead group, while the lactate clearance rate of the survival groupwas significantly higher than that of the dead group （P〈0. 05）. The results indicated that arterial blood lactate level, lactateclearance and APACHE Ⅱ score all were the independent influencing factors on the prognosis of patients with severe waspstings; there was positive correlation between arterial blood lactate levels and APACHE Ⅱ score （r= 0. 824,P〈0. 01） andnegative correlation between 24 h lactate clearance rate and APACHE Ⅱ score （r= 0. 318,P〈0. 01） in the patients withsevere wasp stings; the optimal threshold value of arterial blood lactate for predicting death was 15. 1 mmol/ L, the sensitivity was 86%, and the specificity was 63%; the optimal threshold of lactate clearance for predicting death was 22. 1%, the sensitivity was 62%, and the specificity was 83. 3%. Conclusion The results suggested that arterial blood lactate level and lactate clearance rate had certain clinical application value in disease condition judgment and prognosis evaluation of severe wasp stings, with the advantages of convenience, simplicity and economy as well, Therefore, it was worthy of clinical promotion.