乳酸清除率、SVRI水平及心排量监测与感染性休克患者治疗效果及预后的关系

Relationship between lactic acid clearance,SVRI and cardiac displacement monitoring and the therapeutic effect and prognosis of patients with septic shock

目的研究感染性休克患者乳酸清除率、体循环阻力指数(SVRI)水平及心排量监测与其治疗及预后的关系。方法选取2020年6月至至2022年5月保定市第二中心医院收治的感染性休克患者161例,统计患者临床治疗效果及预后情况,分析影响感染性休克患者治疗疗效、预后的相关因素;采用Pearson相关性分析乳酸清除率、心排血量(CO)、每搏输出量(SV)、SVRI与APACHEⅡ评分的关系。结果161例患者中,有效组90例、无效组71例,两组乳酸、乳酸清除率、CO、SV、体循环阻力指数(SVRI)及APACHEⅡ评分比较,差异均有统计学意义(P<0.05);经Logistic回归分析显示:乳酸(<198mmol/L,>245 mmol/L)、乳酸清除率<10%、CO(<3 L/minm,>6 L/minm)、SV(<60 mL,>120 mL)、SVRI(<1500 dyn/s/m^(-2)/cm^(-5),>2000 dyn/s/m^(-2)/cm^(-5))及APACHEⅡ评分>24分是影响感染性休克患者治疗效果的危险因素(P<0.05)。统计28 d预后情况可知:预后不良者95例,预后良好者66例,两组乳酸、乳酸清除率、CO、SV、SVRI及APACHEⅡ评分比较,差异均有统计学意义(P<0.05)。经Logistic回归分析显示:乳酸(<198 mmol/L,>245 mmol/L)、乳酸清除率<10%、CO(<3 L/minm,>6 L/minm)、SV(<60 mL,>120mL)、SVRI(<1500 dyn/s/m^(-2)/cm^(-5),>2000 dyn/s/m^(-2)/cm^(-5))及APACHEⅡ评分>24分是影响感染性休克患者预后的危险因素(P<0.05)。经Pearson相关性分析结果显示:APACHEⅡ评分与乳酸清除率、CO、SV均呈负相关,与乳酸、SVRI均呈正相关(P<0.05)。结论监测感染性休克患者乳酸清除率、SVRI水平及心排量指标均可为临床评估治疗效果、预后提供有效参考价值。

Objective To study the relationship of lactic acid clearance,systemic resistance index(SVRI)and cardiac displacement monitoring with treatment and prognosis of patients with septic shock.Meth-ods 161 patients with septic shock admitted to the Second Central Hospital of Baoding City from June 2020 to May 2022 were selected.The clinical therapeutic effect and prognosis of patients were counted.The related factors affecting the therapeutic effect and prognosis of patients with septic shock were analyzed.The relationship between lactic acid clearance,cardiac output(CO),stroke output(SV),SVRI and APACHEⅡscore was analyzed by Pearson correlation.Results Among 161 patients,90 cases were in the effective group and 71 cases were in the ineffective group,there were statistically significant in lactic acid,lactic acid clearance,CO,SV,systemic vascular resistance index(SVRI),and APACHEⅡscores(P<0.05).Logistic regression analysis showed that lactic acid<198 mmol/L and lactic acid>245 mmol/L,lactic acid clearance<10%,CO<3 L/minm and CO>6 L/minm,SV<60 mL and SV>120 mL,SVRI<1500 dyn/s/m-2/CM-5 and SVRI>2000 dyn/s/m-2/cm-5 and APACHEⅡscores>24 were risk factors affecting the therapeutic effect of septic shock patients(P<0.05).According to the statistics of the 28 d prognosis,95 cases had poor prognosis and 66 cases had good prognosis.There were significant differences in lactic acid,lactic acid clearance,CO,SV,SVRI and APACHEⅡscores between the two groups(P<0.05).Logistic regression analysis showed that lactic acid<198 mmol/L and lactic acid>245 mmol/L,lactic acid clearance<10%,CO<3 L/minm and CO>6 L/minm,SV<60 mL and SV>120 mL,SVRI<1500 dyn/s/m-2/cm-5 and SVRI>2000 dyn/s/m^(-2)/cm^(-5)and APACHEⅡscores>24 were risk factors affecting the therapeutic effect of septic shock patients(P<0.05).Pearson correlation analysis showed that APACHEⅡscore was negatively correlated with lactic acid clearance,CO and SV,and positively correlated with lactic acid and SVRI(P<0.05).Conclusion Monitoring lactate clearance,SVRI level and cardiac displacement in patients with septic shock can provide effective reference value for clinical evaluation of treatment effects and prognosis.