乳酸和乳酸清除率对脓毒症病情判断及预后评估的应用效果

Evaluation of the Effect of Lactic Acid and Lactic Acid Clearance Rate on Sepsis Diagnosis and Prognosis Evaluation

目的:评价乳酸和乳酸清除率对脓毒症患者病情判断及预后评估的临床价值,为脓毒症患者诊治方案制定提供参考。方法:纳入2017年1月-2019年1月在笔者所在医院治疗的符合纳入条件的脓毒症患者202例作为研究对象,所有患者均于确诊时入组,并完善基础检查,对患者进行不同阶段乳酸(LAC)、乳酸清除率(LCR)、降钙素原(PCT)、C反应蛋白(CRP)进行监测,并于同时段行脓毒症相关序贯器官衰竭(SOFA)测评。根据患者脓毒症病情严重程度将其分为脓毒症组(n=115)和脓毒症休克组(n=87)。治疗28 d统计存活与死亡情况。分别比较脓毒症组、脓毒症休克组及存活组和死亡组确诊时、确诊后24、48、72 h的乳酸、LCR、PCT、CRP及SOFA水平。采用Pearson分析所有患者LAC、LCR与脓毒症病情程度、死亡的相关性。结果:脓毒症休克组确诊时、确诊后24、48、72 h LAC、PCT、CRP及SOFA评分均高于脓毒症组(P<0.05),而LCR脓毒症休克组明显低于脓毒症组(P<0.05)。治疗后28 d死亡46例,存活156例,死亡组患者确诊时、确诊后24、48、72 h LAC、PCT、CRP及SOFA评分均高于存活组(P<0.05),LCR则低于存活组(P<0.05)。Pearson分析显示,LAC与病情严重程度、死亡呈正相关(r=0.583、0.602,P<0.05),LCR与脓毒症患者病情严重程度及死亡呈负相关(r=-0.611、-0.593,P<0.05)。结论:乳酸和乳酸清除率在脓毒症患者不同阶段对脓毒症患者病情严重程度的判断及预后评估具有一定的临床价值。

Objective:To evaluate the clinical value of lactic acid and lactate clearance rate in judging the condition and prognosis of patients with sepsis,so as to provide reference for the development of diagnosis and treatment plan for sepsis patients.Method:A total of 202 patients with sepsis who met the inclusion criteria in our hospital from January 2017 to January 2019 were included as the research objects.All patients were enrolled in the group at the time of diagnosis.The basic examination of all patients was improved.Lactate(LAC),lactate clearance rate(LCR),procalcitonin(PCT)and C-reactive protein(CRP)were monitored at different stages,and were performed sepsis related sequential organ failure(SOFA)assessment at the same time.According to the severity of sepsis,the patients were divided into sepsis group(115 cases)and septic shock group(87 cases).After 28 days of treatment,the survival and death cases were counted.The levels of lactic acid,LCR,PCT,CRP and SOFA in sepsis group and septic shock group,survival group and death group were compared at the time of diagnosis and 24,48 and 72 hours after diagnosis.Pearson was used to analyze the correlation between LAC,LCR and severity of sepsis and death.Result:The scores of LAC,PCT,CRP and SOFA in septic shock group were higher than those in sepsis group at diagnosis and 24 h,48 h and 72 h after diagnosis(P<0.05),while LCR score in septic shock group was significantly lower than that in sepsis group(P<0.05).After 28 days of treatment,46 cases died and 156 cases survived,the scores of LAC,PCT,CRP and SOFA in death group were higher than those in survival group(P<0.05),and LCR was lower than that in survival group(P<0.05).Pearson analysis showed that LAC was positively correlated with the severity and death of sepsis(r=0.583,0.602,P<0.05),and LCR was negative correlated with the severity and death of sepsis(r=-0.611,-0.593,P<0.05).Conclusion:Lactate and lactate clearance rate in different stages of sepsis patients in the judgment of severity and prognosis of patients with sepsis has a certain clinical value.