动脉血乳酸、乳酸清除率与重症肺炎机械通气患者APACHEⅡ评分及预后的相关性

Correlation between arterial blood lactate acid,lactate clearance rate and APACHEⅡscores,prognosis in patients with severe pneumonia undergoing mechanical ventilation

目的分析动脉血乳酸(LA)、乳酸清除率(LCR)水平与重症肺炎(SP)机械通气患者急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及预后的相关性。方法分析2018年10月至2020年4月收治的71例SP机械通气患者的临床资料,根据入院时LA水平分为LA正常组(LA<2.0 mmol/L,29例)、轻度升高组(2.0 mmol/L≤LA<4.0 mmol/L,13例)和重度升高组(LA>4.0 mmol/L,29例);根据10 h LCR分为低LCR组(LCR≤0,33例)、中LCR组(0<LCR≤10%,16例)、高LCR组(LCR>20%,22例)。对比组间APACHEⅡ评分及28 d病死率,分析LA、LCR水平与患者APACHEⅡ评分及预后的相关性,以ROC曲线评价LA、LCR预测预后的价值。结果不同LA水平的3组患者APACHEⅡ评分及28 d病死率比较差异有统计学意义(P<0.05);与乳酸正常组相比,重度升高组的APACHEⅡ评分及28 d病死率均明显上升(P<0.05)。不同LCR的3组患者APACHEⅡ评分及28 d病死率比较差异有统计学意义(P<0.05);与低LCR组相比,中LCR组的APACHEⅡ评分明显下降,高LCR组的APACHEⅡ评分及28 d病死率均明显下降(P<0.05)。相关性分析显示:SP机械通气患者的LA水平与APACHEⅡ评分呈正相关、与预后呈负相关(P<0.05);LCR水平与APACHEⅡ评分呈负相关,与预后呈正相关(P<0.05)。ROC曲线显示,LCR预测患者预后的AUC值(0.845)明显高于LA(0.703)(P<0.05)。结论SP机械通气患者的LA、LCR水平与APACHEⅡ评分及预后密切相关,监测LA指标变化,尤其是LCR变化能有效预测预后。

Objective To investigate the correlation between arterial blood lactic acid(LA),lactate clearance rate(LCR)and scores of acute physiology and chronic health scoring systemⅡ(APACHEⅡ),prognosis in patients with severe pneumonia(SP)undergoing mechanical ventilation.Methods The clinical data about 71 patients with SP who were treated by mechanical ventilation were retrospectively analyzed.According to the level of LA on admission,these patients were divided into normal lactic acid group(LA<2.0mmol/L,n=29),moderate increase group(2.0mmol/L≤LA<4.0mmol/L,n=13)and obvious increase group(LA>4.0mmol/L,n=29).According to 10h LCR,who were into low LCR group(LCR≤0,n=33),moderate LCR group(0<LCR≤10%,n=16),high LCR group(LCR>20%,n=22).The APACHEⅡscore and 28-day mortality rate were observed and compared among groups,and Spearman correlation was used to analyze the correlation between the levels of LA,LCR and APACHEⅡscore as well as the prognosis of patients.The ROC curve was used to evaluate the value of LA and LCR in predicting the prognosis.Results There were significant differences in the APACHEⅡscore and 28d mortality rate among the three groups with different LA levels(P<0.05).As compared with those in normal lactic acid group,the APACHEⅡscores in moderate increase group were decreased significantly,and the APACHEⅡscore and 28-day mortality in obvious increase group were increased significantly(P<0.05).As compared with those in low LCR group,the APACHEⅡscores in moderate LCR group were decreased significantly,and the APACHEⅡscore and 28d mortality rate in high LCR group were decreased significantly(P<0.05).The results of correlation analysis showed that the LA levels were positively correlated with the APACHEⅡscores,however,which were negatively correlated with prognosis of patients(P<0.05).Moreover the LCR levels were negatively correlated with APACHEⅡscore and positively correlated with the prognosis of patients(P<0.05).The ROC curve results showed that the AUC value(0.845)of LCR in predicting patient’s prognosis was significantly higher than that(0.703)of LA(P<0.05).Conclusion The levels of LA and LCR are closely related to APACHEⅡscores and prognosis of patients with SP undergoing mechanical ventilation.Monitoring the changes of LA indexes,especially LCR,can effectively predict the prognosis of patients.