早期血清乳酸清除率预测脓毒症患者预后的价值

Value of early serum lactate clearance in predicting prognosis of septic patients

目的评估早期乳酸清除率预测脓毒症患者预后的临床价值。方法选取2015年5月-2017年5月在解放军总医院第一医学中心急诊就诊的198例脓毒症患者,回顾入院6 h时乳酸清除率等指标并随访3个月的生存结局,采用单因素和多因素分析评估早期乳酸清除率与患者死亡风险的相关性。结果本研究共纳入198例脓毒症患者,其中男性106例,女性92例,平均年龄为(58.6±13.2)岁,整体死亡率为22.7%。死亡组与存活组相比,在SOFA评分、APACHEⅡ评分、ScvO2、PvaCO2、早期乳酸清除率5个指标上差异有统计学意义(P均<0.05)。多因素logistic回归分析显示早期乳酸清除率低(OR=2.398)和APACHEⅡ评分高(OR=1.523)是脓毒症患者死亡的独立危险因素(P均<0.05)。结论早期乳酸清除率是预测脓毒症患者预后的有效指标。

Objective To investigate the clinical significance of early lactate clearance in predicting prognosis of septic patients.Methods One hundred and ninety-eight patients admitted to the emergency department of the First Medical Center of Chinese PLA General Hospital from May 2015 to May 2017 were included in this study.The early serum lactate clearance of all patients was detected within 6h after admission.All patients were followed up for 3 months.The relationship between early serum lactate clearance and mortality was assessed using univariate and multivariate analysis.Results Of the 198 patients,there were 106 males and 92 females with average age of(58.6±13.2)years and the mortality rate was 22.7%.The early lactate clearance of non-survivors was significantly lower than that of survivors(12.8%±8.1%vs 25.7%±12.3%,P<0.001),which was furtherly confirmed by multivariate logistic regression(OR=1.523;P=0.022).Conclusion Early serum lactate clearance is associated with tissue perfusion and prognosis in septic patients,which may be contribute to prediction of the mortality.