动脉血乳酸水平在感染性休克患者预后评价中的价值研究

Prognostic value of arterial blood lactic acid in septic shock patients

目的:研究动态检测动脉血乳酸水平对感染性休克患者预后评价的价值,以期为感染性休克的治疗提供一定的参考。方法:选取2011-01~2014-12入院诊治的伴有动脉血乳酸水平升高的(≥2.0mmol/L)感染性休克患者180例。根据其生存状态分为死亡组(86例)与存活组(94例),观察并比较两组患者动脉血乳酸检测水平,同时分析动脉血乳酸水平与急性生理和慢性健康状况(APACHE II)评分及多脏器功能障碍综合征(MODS)发生率等预后指标的相关性。结果:死亡组进入重症监护室后0、6、24、48h的动脉血乳酸水平均显著高于存活组(P<0.05),存活组6、24h乳酸清除率<10%的比例明显低于死亡组(P<0.05)。入组时动脉血乳酸水平>4mmol/L、6h乳酸清除率<10%、EGDT未达标、入组APACHE II评分>20分及发生MODS是影响感染性休克预后的相关因素。经多元Logistic回归分析,6h乳酸清除率与24h动脉血乳酸水平是评价感染性休克患者预后的独立危险因素。结论:动脉血乳酸水平升高,6h乳酸清除率低是感染性休克患者预后不良的危险因素,高乳酸患者应尽早治疗。

Objective:To provide clinical consultation for the treatment of septic shock by evaluating the dynamic changes of lactic acid in the arterial blood of septic shock patients.Methods:A total of 180 septic shock patients who were admitted in our hospital from Jan.2011 to Dec.2014 with increased lactic acid in arterial blood were retrospectively analysed.The patients were divided into death group(86cases)and survival group(94cases).The level of lactic acid in arterial blood were detected with analysis of parameters including APACHE II score and MODS occurrence rate.Results:The level of lactic acid at 0h,6h,24 h,48h(time after entering ICU)were significantly higher in death group than that in survival group(P<0.05).The<10%rate of lactic acid clearance at 6h,24 hwere significantly lower in survival group than that in death group(P<0.05).The relevant factors of septic shock included lactic acid concentration(>4mmol/L)in arterial blood,the<10%rate of lactate clearance at 6h,APACHE II score>20and the occurence of MODS.Conclusion:The rate of lactic acid clearance at 6hand lactic acid level at 24 hwere independent risk factors in the prognosis of septic shock.Patients with high lactic acid in arterial blood should be treated as soon as possible.