血乳酸检测在失血性低血容量休克预后评估中的临床意义

Clinical significance of blood lactic acid test in prognostic evaluation of hemorrhagic hypovolemic shock

目的分析血乳酸检测在失血性低血容量休克预后评估中的临床意义。方法回顾性选取2019年8月至2021年8月空军军医大学第一附属医院收治的120例失血性低血容量休克患者作为观察组,另选取同期门诊体检的120名健康人群作为对照组。两组均进行血乳酸检测,计算乳酸清除率(LCR),比较观察组、对照组血乳酸水平。观察组根据LCR分为高LCR组(n=63)和低LCR组(n=57),比较两组入院24 h血乳酸水平、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、不良事件总发生率。根据观察组入院24 h是否好转,分为好转组(n=55)和未好转组(n=65),比较两组入院24 h血乳酸水平、APACHEⅡ评分、不良事件总发生率。采用Pearson相关系数分析LCR与APACHEⅡ评分相关性。结果观察组血乳酸水平为(8.62±1.95)mmol/L,高于对照组[(5.26±0.34)mmol/L],差异有统计学意义(P<0.05)。高LCR组血乳酸水平、APACHEⅡ评分、不良事件总发生率分别为(4.16±0.62)mmol/L、(14.26±1.27)分、1.59%,均分别低于低LCR组[(7.85±1.44)mmol/L、(21.95±3.44)分、12.28%],差异均有统计学意义(P<0.05)。好转组血乳酸水平、APACHEⅡ评分、不良事件总发生率分别为(4.06±0.34)mmol/L、(13.02±2.62)分、1.69%,均分别低于未好转组[(7.95±1.46)mmol/L、(20.95±3.75)分、11.48%],差异均有统计学意义(P<0.05)。Pearson相关系数分析结果显示,LCR与APACHEⅡ评分呈正相关(r=4.625,P<0.05)。结论失血性低血容量休克患者随着病情的加重,血乳酸水平会逐渐增高,通过检测血乳酸并计算LCR,可对患者预后作出准确的评估。

Objective To analyze the clinical significance of blood lactate detection in the prognostic evaluation of hemorrhagic hypovolemic shock.Methods A total of 120 patients with hemorrhagic hypovolemic shock admitted to the First Affiliated Hospital of Air Force Medical University from August 2019 to August 2021 were retrospectively selected as the observation group,while 120 healthy individuals who underwent outpatient examinations during the same period were selected as the control group.The blood lactic acid of both groups was tested,the lactate clearance rate(LCR) was calculated.The levels of blood lactate in the observation group and the control group were compared.The observation group was divided into the high LCR group(n=63) and the low LCR group(n=57) according to LCR,and the blood lactate levels of 24-hour upon admission,acute physiology and chronic health status evaluation Ⅱ(APACHE Ⅱ) scores,and total incidence of adverse events were compared between two groups.According to whether the observation group got better 24 hours after admission,they were divided into the improved group(n=55) and the non-improved group(n=65),the levels of blood lactate,APACHE Ⅱ scores,and the total incidence of adverse events were compared between the two groups at 24 hours after admission.The correlation between LCR and APACHE Ⅱ score was analyzed by Pearson correlation coefficient.Results The level of blood lactate in the observation group was(8.62±1.95) mmol/L,which was higher than that in the control group[(5.26±0.34) mmol/L],and the difference was statistically significant(P<0.05).The level of blood lactate,the APACHE Ⅱ score and the total incidence of adverse events in the high LCR group were(4.16±0.62) mmol/L,(14.26±1.27) points,and 1.59%,respectively,which were lower than those in the low LCR group [(7.85±1.44) mmol/L and(21.95±3.44) points,12.28%],and the differences were statistically significant(P<0.05).The level of blood lactate,the APACHE Ⅱ score and the total incidence of adverse events in the improved group were(4.06±0.34) mmol/L,(13.02±2.62) points,and 1.69%,respectively,which were lower than those in the non-improved group [(7.95±1.46) mmol/L,(20.95±3.75) points,and 11.48%],and the differences were statistically significant(P<0.05).There was a positive correlation between LCR and APACHEⅡ score according to the result of Pearson correlation coefficient(r=4.625,P<0.05).Conclusion As the condition of hemorrhagic hypovolemic shock patients gets worse,the blood lactate level will gradually increase.By detecting the blood lactate and calculating the LCR,the prognosis of the patient can be accurately assessed.