乳酸及乳酸清除率对烧伤休克患者预后的预测价值

Prognosis value of lactate and lactate clearance rate in patients during burn shock stage

目的:探讨血乳酸及乳酸清除率对烧伤休克期患者预后的预测价值。方法:对我院烧伤科收住的88例休克期血乳酸>2.0 mmol/L的患者进行回顾性分析,按住院28 d是否存活将患者分为存活组(48例)和死亡组(40例)。测定入院时(0 h)及入院后6 h、12 h、24 h和72 h血乳酸水平,同时记录血氧分压,并进行急性生理与慢性健康评分Ⅱ。分析0 h静脉血乳酸的水平、PO2与APACHEⅡ评分的相关性;分析各时间点的乳酸清除率与预后的关系;分析血乳酸水平、乳酸清除率、APACHEⅡ评分和28天死亡情况的关系。结果:死亡组患者0 h、6 h、12 h、24 h和72 h血乳酸水平均显著高于存活组。所有烧伤休克患者入院时的血乳酸水平与入院时的APACHEⅡ评分呈现出明显的相关性(P<0.01),而血氧分压与APACHEⅡ评分无相关性(P>0.05)。多因素logistic回归分析结果表明,6 h和12 h的乳酸清除率可作为预后因素,独立对预后进行评价。结论:动态监测血乳酸对烧伤休克期患者具有重要意义,持续性高乳酸血症预示预后不良,6 h和12 h乳酸清除率可用作预后指标。

Objective:To investigate the prognosis value of lactate and lactate clearance rate in patients during burn shock stage.Methods:88 patients with blood lactate>2.0 mmol/L during burn shock in the hosptital burn unit were retrospectively analyzed.The patients were divided into survivor group(n=48)and death group(n=40)according to whether they survived on 28th day.Blood lactate levels were measured at admission(0 h)and at 6 h,12 h,24 h and 72h after admission.The partial pressure of blood oxygen was recorded,as well as the acute physiology and chronic health evaluation(APACHEⅡ).The correlation of the lactate blood level at 0 h,PO2 between APACHEⅡscores,and the relationship between lactate clearance and prognosis was analyzed at each time point.Results:Blood lactate levels at 0 h,6 h,12 h,24 h and 72 h in the death group were significantly higher than those in the surviving group,resoectively.Lactate levels of patients during burn shock on admission were significantly associated with APACHEⅡscores(P<0.01),but not with partial pressure of oxygen(P>0.05).Multivariate logistic regression analysis showed that the lactate clearance rate at 6 h and 12 h could be used as a prognostic factor to independently evaluate the prognosis.Conclusions:The dynamic monitoring of blood lactate is of great significance in patients with burn shock.Persistent hyperlactacidemia indicates a poor prognosis.The lactic acid clearance rate at 6 h and 12 h may be used as indices for prognostic evaluation.