危重症病人动脉血乳酸与急性皮肤衰竭的相关性研究

Correlation between arterial blood lactic acid and acute skin failure in critically ill patients

目的:探讨危重症病人动脉血乳酸与急性皮肤衰竭发生的相关性及对急性皮肤衰竭的预测价值。方法:便利抽取2020年7月—2021年9月青岛市某三级甲等医院急诊监护室收治的123例危重症病人作为研究对象,检测病人入急诊监护室后动脉血乳酸水平,分析动脉血乳酸与急性皮肤衰竭的相关性,确定动脉血乳酸预测急性皮肤衰竭发生的最佳截断值。结果:123例病人中,急性皮肤衰竭发生率为83.7%;动脉血乳酸与发生皮肤衰竭症状的数目和皮肤花斑评分呈正相关(P<0.05)。入急诊监护室后首次动脉血乳酸与诊断为脓毒性休克后24 h内的动脉血乳酸预测病人急性皮肤衰竭的受试者工作特征(ROC)曲线下面积分别为0.847和0.814,预测急性皮肤衰竭发生的最佳截断值分别为1.65 mmol/L和3.35 mmol/L。结论:危重症病人的动脉血乳酸与急性皮肤衰竭呈正相关,入急诊监护室后首次动脉血乳酸≥1.65 mmol/L及发生脓毒性休克后24 h内动脉血乳酸≥3.35 mmol/L时,应警惕病人发生急性皮肤衰竭。

Objective:To investigate the correlation between arterial blood lactic acid and acute skin failure(ASF)in critically ill patients and its predictive value for ASF. Methods:From July 2020 to September 2021,a total of 123 critically ill patients admitted to the Emergency Intensive Care Unit(EICU)of a tertiary grade A hospital in Qingdao city were conveniently selected as the research subjects.Detected patients′ arterial blood lactic acid when they were admitted to EICU,analyzed the correlation between the arterial blood lactic acid and ASF,and determined the optimal cut-off value of arterial blood lactic acid for predicting the occurrence of ASF. Results:Among the 123 patients,the incidence of ASF was 83. 7%;arterial blood lactic acid was positively correlated with the number of ASF symptoms and mottled skin score(P<0. 05). After admission to EICU,the area under the ROC curve of the first arterial blood lactic acid and the arterial blood lactic acid within 24 hours after the diagnosis of septic shock were 0. 847 and 0. 814,respectively,and the best cut-off values for predicting the occurrence of ASF were 1. 65 mmol/L and 3. 35 mmol/L,respectively. Conclusions:The arterial blood lactic acid in critically ill patients was positively correlated with ASF. When the arterial blood lactic acid is≥1. 65 mmol/L for the first time after admission to EICU and the arterial blood lactic acid≥3. 35 mmol/L within 24 hours after septic shock,ASF should be alerted to occur in patients.