感染性休克患者24 h时动脉血乳酸水平的影响因素

Influencing factors of arterial blood lactate level in septic shock patients within 24 h

目的分析影响感染性休克患者24 h高血乳酸值的因素。方法纳入2014年7月至2019年4月徐州医科大学附属医院收治的感染性休克患者150例为研究对象。依据24 h时血乳酸值分为2组:<4 mmol/L者纳入对照组,≥4 mmol/L者纳入观察组,每组75例。收集患者的人口学资料、临床和实验室数据,随访28 d,考察患者生存情况。使用SPSS 22.0软件进行统计分析。采用Cox回归模型分析影响24 h乳酸值的因素。采用Kaplan-Meier法绘制生存曲线,比较组间生存率。结果多因素Cox比例风险回归分析结果显示,急性生理与慢性健康评估量表(APACHE)Ⅱ评分(HR=1.452,95%CI 1.103~1.901;P=0.008)是影响感染性休克患者早期高乳酸血症的独立危险因素,而白蛋白水平(HR=0.889,95%CI 0.886~0.999;P=0.001)是影响感染性休克患者24 h高乳酸血症的独立保护性因素。Kaplan-Meier生存曲线结果显示,观察组患者28 d的累计生存率显著低于对照组(χ^2=15.632,P<0.001)。结论24 h时血乳酸水平能有效评估感染性休克患者的预后。较高的APACHEⅡ评分及较低的白蛋白水平是影响24 h乳酸水平升高的重要因素。

Objective To investigate the factors affecting 24-hour high blood lactate in patients with septic shock.Methods A total of 150 patients with septic shock admitted to our department of critical care medicine from July 2014 to April 2019 were enrolled in this study.According to their blood lactate level within 24 h,they were divided into control group(<4 mmol/L,n=75)and observation group(≥4 mmol/L,n=75).Their demographic data,clinical data and results of laboratory tests were collected.SPSS statistics 22.0 was used for data analysis.Cox regression model was used to analyze the factors affecting 24 h lactate level.Kaplan-Meier survival analysis was employed to draw survival curve and compare the survival rate between the two groups.Results The results of multivariate Cox proportional-hazards regression analysis showed that the score of acute physiology and chronic health evaluation(APACHEⅡ)was an independent risk factor(HR=1.452,95%CI 1.103-1.901,P=0.008),while albumin level was an independent protective factor(HR=0.889,95%CI 0.886-0.999,P=0.001)for early hyperlactaemia in septic shock patients.Kaplan-Meier survival curve indicated that the 28-day cumulative survival rate was significantly lower in the observation group than the control group(χ^2=15.632,P<0.001).Conclusion Blood lactate level within 24 h can effectively evaluate the prognosis of septic shock patients.Higher APACHEⅡscore and lower albumin level are the important factors influencing the increase of lactate level.