乳酸清除率和APACHEⅡ评分在评估老年脓毒性休克患者预后中的应用价值

Application value of lactic acid clearance rate and APACHEⅡscore in evaluating prognosis of elderly patients with septic shock

目的:研究乳酸清除率和APACHEⅡ评分在评估老年脓毒性休克患者预后中的应用价值。方法:选取北京市石景山医院接诊的老年脓毒性休克患者97例,参照《国际严重脓毒症与感染性休克治疗指南》中建议的疗法对其进行复苏治疗。监测其入院后动脉血乳酸的水平,计算其6 h乳酸清除率。根据6 h乳酸清除率将其分为高清除组和低清除组,根据其进入ICU 28 d后的生存情况将其分为存活组和死亡组,同时记录其入院24 h内急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)的评分。结果:高清除率组患者的APACHEⅡ评分低于低清除率组患者的APACHEⅡ评分,其入住ICU的时间短于低清除率组患者入住ICU的时间,P<0.05。死亡组患者入院后初始动脉血乳酸的水平、APACHEⅡ评分均高于存活组患者入院后初始动脉血乳酸的水平、APACHEⅡ评分,其入住ICU的时间长于存活组患者入住ICU的时间,其6 h乳酸清除率低于存活组患者的6 h乳酸清除率,P<0.05。结论:乳酸清除率和APACHEⅡ评分在评估老年脓毒性休克患者预后中的应用价值较高。

Objective:To study the application value of lactic acid clearance rate and APACHEⅡscore in evaluating the prognosis of elderly patients with septic shock.Methods:97 elderly patients with septic shock admitted to Beijing Shijingshan Hospital were selected and resuscitated according to the therapy recommended in the International Guidelines for the Treatment of Severe Sepsis and Septic Shock.The level of arterial blood lactic acid was monitored after admission,and the lactic acid clearance rate was calculated at 6 h.According to lactate clearance rate at 6 h,the patients were divided into high clearance group and low clearance group,and survival group and death group according to their survival after 28 days in ICU.Meanwhile,the acute physiological and chronic health status scoring systemⅡ(APACHEⅡ)within 24 h of admission was recorded.RESULTS:The APACHEⅡscore of the high clearance group was lower than that of the low clearance group,and the ICU admission time of the high clearance group was shorter than that of the low clearance group,P<0.05.The initial level of arterial blood lactic acid and APACHEⅡscore in the death group after admission were higher than those in the survival group,and the time of stay in ICU was longer than that in the survival group,and the 6-h lactate clearance rate was lower than that in the survival group,P<0.05.Conclusion:Lactic acid clearance rate and APACHEⅡscore are of high application value in evaluating the prognosis of elderly patients with septic shock.