早期乳酸清除率对重症社区获得性肺炎合并高乳酸血症患者预后的评估作用

目的研究早期乳酸清除率对重症社区获得性肺炎合并高乳酸血症患者预后的评估作用。方法回顾性分析58例重症社区获得性肺炎合并高乳酸血症患者，计算患者开始治疗24小时后的乳酸清除率，PSI及CURB-65评分变化率，将研究对象分别分为存活组与死亡组、高乳酸清除率组与低乳酸清除率组。比较存活组与死亡组之间的起始乳酸浓度、治疗24小时后乳酸清除率及PSI和CURB-65评分变化率并比较高乳酸清除率组与低乳酸清除率组治疗24小时后的死亡率、休克发生率和呼衰发生率有无差异。结果存活组与死亡组的起始乳酸浓度、PSI评分变化率差异无统计学意义，乳酸清除率及CURB-65变化率存活组明显高于死亡组；高乳酸清除率组治疗24小时后的死亡率、休克发生率和呼衰发生率明显低于低乳酸清除率组。结论治疗24小时后的乳酸清除率是评价重症社区获得性肺炎合并高乳酸血症患者病情严重程度、治疗效果和判断预后的重要指标之一。

Evaluating effect of early lactate clearance on prognosis of severe community acquired pneumonia with hyperlactacidemia

Objective To retrospectively study the effect of early lactate clearance on prognosis of severe community acquired pneumonia with hyperlactacidemia. Methods 58 cases were studied retrospectively. Lactate clearance, PSI and CURB-65 score variance were calculated after 24 hours＇ treatment. Survivor and nonsurvivor, high lactate clearance and low lactate clearance groups were divided respectively among the cases. Initial lactate, lactate clearance, PSI and CURB-65 score variance after 24 hoursttreatment were compared between survivor and nonsurvivor groups. Mortality, shock incidence and respiratory failure incidence after 24 hours＇treatment were compared between the high lactate clearance and the low lactate clearance groups. Results The difference of initial lactate, PSI score variance between survivor and nonsurvivar groups showed no statistical significance. The lactate clearance and CURB-65 score variance of survivor group were obviously higher than those of the nonsurvivor group. Mortality, shock incidence and respiratory failure incidence after 24 hours＇treatment in the high lactate clearance group were obviously lower than those in the low lactate clearance group. Conclusion Lactate clearance after 24 hours＇treatment is one of the important markers to evaluate the severity, therapeutic effect and prognosis of severe community acquired pneumonia patients with hyperlactacidemia.