急性呼吸窘迫综合征患者乳酸清除率的动态变化及临床意义

Dynamic changes and clinical significance of lactate clearance rate in patients with acute respiratory distress syndrome

目的:观察急性呼吸窘迫综合征(ARDS)患者6 h乳酸清除率的动态变化及临床意义。方法:选择2017年1月至2019年1月本院重症医学科收治的ARDS患者37例为观察组,同时期非ARDS患者30例作为对照组;根据预后将ARDS患者细分为好转、加重和死亡组;记录入ICU第1天、第2天、第7天中性粒细胞百分比(NEUT%)、6 h乳酸清除率、降钙素原(PCT)、氧合指数等指标,并记录对应时间点的APACHEⅡ评分及最后患者监护室停留时间;比较不同亚组之间乳酸清除率的变化特点,分析其与APACHEⅡ评分、监护室停留时间的相关性,最后采用受试者工作特征曲线(ROC)对比乳酸清除率的评估价值。结果:入ICU第1天,观察组患者6 h乳酸清除率和氧合指数显著低于对照组(P<0.05)。在观察组中,与入ICU第1天比较,好转组第2、7天PCT逐渐降低,氧合指数逐渐改善,6 h乳酸清除率逐渐上升(P<0.05);加重组第7天PCT升高,氧合指数和6 h乳酸清除率降低(P<0.05);死亡组第2、7天PCT逐渐升高,氧合指数、6 h乳酸清除率逐渐下降(P<0.05);ARDS患者6 h乳酸清除率与APACHEⅡ评分与监护室停留时间均呈负相关,且乳酸清除率对ARDS病情评估优于氧合指数与PCT(曲线下面积分别为0.842、0.797和0.696)。结论:ARDS患者6 h乳酸清除率与疾病严重程度及预后密切相关,其动态变化可作为判断临床疗效与病情变化的重要参考。

Objective:To investigate the dynamic changes and clinical significance of 6 h lactate clearance rate in patients with acute respiratory distress syndrome(ARDS).Methods:A total of 37 patients with ARDS admitted in our hospital from Jan 2017 to Jan 2019 were selected as the observation group,and 30 non-ARDS patients in the same period were selected as the control group.ARDS patients were subdivided into improved,worsened,and dead groups based on prognosis.Neutrophilic granulocyte percentage(NEUT%),6 h lactate clearance rate,procalcitonin(PCT)and oxygenation index were recorded on the 1st,2nd and 7th days after ICU admission,and the APACHEⅡscore at the corresponding time point and stay time in the care unit were recorded.The characteristics of changes in lactate clearance rate between different subgroups were compared,their correlation with APACHEⅡscore and stay time in the care unit were analyzed,and receiver operating curve(ROC)was used to compare the evaluation value of lactate clearance rate.Results:Oxygenation index and 6 h lactate clearance rate in the observation group was lower than those in the control group on the 1st day after ICU admission(P<0.05).In the observation group,compared with the 1st day after ICU admission,PCT gradually decreased,the oxygenation index gradually improved,and the 6 h lactate clearance rate gradually increased in the improved group on the 2nd and 7th days(P<0.05).And PCT increased significantly,oxygenation index and 6 h lactate clearance rate decreased in the worsened group on the 7th day(P<0.05).In the dead group,PCT gradually increased,oxygenation index and 6 h lactate clearance rate gradually decreased on the 2nd and 7th days after ICU admission(P<0.05).And 6 h lactate clearance rate of ARDS patients was negatively correlated with APACHEⅡscore and stay time in the care unit.The lactate clearance rate was superior to the oxygenation index and PCT in assessing ARDS(area under the curve was 0.842,0.797 and 0.696 respectively).Conclusion:The 6 h lactate clearance rate of ARDS patients is closely related to disease severity and prognosis,and its dynamic changes can be used as an important reference for judging clinical efficacy and disease changes.