动脉血乳酸及早期乳酸清除率对COPD合并呼吸衰竭患者预后的评估价值

Assessment value of arterial blood lactate and early lactate clearance in prognosis of COPD patients with respiratory failure

目的分析动脉血乳酸及早期乳酸清除率(LCR)对慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者预后的评估价值。方法分析本院80例COPD合并呼吸衰竭患者的临床资料,并根据其入院时的动脉血乳酸水平,将患者分为乳酸正常组、轻度升高组和重度升高组,比较组间的临床相关指标。同时根据患者的6h乳酸清除率,将患者分为高LCR组和低LCR组,比较2组治疗前、治疗后6h乳酸水平和动脉血气分析结果,并分析其与患者预后的相关性。结果乳酸轻度组、重度升高组的APACHEⅡ、机械通气时间、住院时间、30d病死率均较乳酸正常组增加(P<0.05);治疗后高LCR组患者的动脉血乳酸、APACHEⅡ评分均低于治疗前,血气分析结果较治疗前均有显著改善(P<0.05);高LCR组的各指标改善情况均显著优于低LCR组(P<0.05)。患者预后的危险因素为APACHEⅡ、机械通气时间,6hLCR是影响患者预后的保护因素(P<0.05)。结论早期乳酸清除率与呼吸衰竭患者的病情变化密切相关,并对患者的预后具有较好的参考价值。

Objective To analyze the assessment value of arterial blood lactic acid and early lactate clearance rate ( LCR) in the prognosis of chronic obstructive pulmonary disease ( COPD) patients with respiratory failure. Methods The clinical data of 80 COPD patients with respiratory failure in our hospital were analyzed. According to the arterial blood lactic acid levels at admission,patients with normal lactic acid,mildly elevated and severely elevated groups were compared. At the same time, according to the patient's 6 h lactate clearance rate,the patients were divided into high LCR group and low LCR group to compare the lactate levels and arterial blood gas analysis results before and after treatment,and the correlation with the prognosis of the patients was analyzed. Results APACHEⅡ,mechanical ventilation time,hospitalization time and 30-day mortality rate of the mild and severe lactic acid groups were significantly higher than those of the normal lactic acid group ( P < 0. 05). Blood lactate and APACHEⅡ scores were significantly lower than before treatment,and blood gas analysis results were significantly improved compared with before treatment ( P < 0. 05). The improvement of each index in the high LCR group was significantly better than that in the low LCR group ( P < 0. 05). The risk factors for patient's prognosis were patient's APACHEⅡ and mechanical ventilation time,and 6 h LCR was a protective factor influencing the prognosis of patients ( P < 0. 05). Conclusion The early lactate clearance rate is closely related to the change of the condition of patients with respiratory failure,and has a good reference value for the prognosis of patients.