ICU危重患者血乳酸变化水平与预后晌关系探讨

目的：探讨重症监护病房（ICU）内血乳酸增高的危重病患者的乳酸水平变化情况与7d、28d预后的关系。方法：收集ICU内动脉血乳酸水平升高的患者共133例，比较7d、28d的病死率。按7d、28d存活或死亡情况分组观察一般资料、乳酸指标（／kICU乳酸高值，8h、24h乳酸清除率）、住ICU天数、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。分别按入院乳酸高值分组、按8h、24h乳酸清除率分组、按高乳酸时间分组比较各组患者的一般资料、APACHEⅡ评分、7d和28d病死率。结果：住ICU乳酸升高患者28d病死率较7d病死率明显升高（P〈0.01）。7d、28d死亡组患者乳酸值、APACHEⅡ评分均显著高于生存组（P〈0．05、0.01），乳酸8。h清除率、24h清除率均显著低于生存组（P〈0.01）。严重乳酸酸中毒组7d病死率、APACHEⅡ评分明显高于高乳酸血症组（P〈O．01、0．05），28d病死率无明显差异；而高乳酸血症组与乳酸酸中毒组之间观察值均无明显差异。各高清除率组与低清除率组比较，7d、28d病死率均明显降低（P〈O．01），各中、低清除率组之间比较仅24h低清除率组28d病死率较中清除率组明显升高（P〈O．01），其余各观察值均无明显差异。高乳酸时间〉8hell、〉24h组7d、28d病死率均较〈8h组明显升高（P〈O．01），且28d病死率较7d病死率组明显升高（P〈O．05）。结论：ICU病房内血乳酸水平增高的危重病患者28d的总体病死率比7d病死率明显增加。人院血乳酸水平、乳酸清除率、高乳酸时间均是评估患者预后的良好指标，而且随着高乳酸时间的延长，28d病死率比7d病死率明显增高，在8h内将血乳酸降至正常范围内可能改善危重患者的预后。

The study of relationship between the change of blood lactate level and prognosis of critically ill patients in intensive care unit

Abstract Objective.. To study the relationship between the change of blood lactate level and the prognosis of critically ill patients in intensive care unit（ICU）. Method：One hundred and thirty-three cases of patients with ele- vated arterial blood lactate levels in ICU were collected in Our study. The mortality of 7 d and 28 d was analyzed. All the patients were grouped according to the survival of 7 d, 28 d, and the general information,lactate index （peak lactate level in ICU,8 h,24 h lactate clearance rate） ,the clays that stay in ICU,acute physiology and chronic health evaluation score l] （APACHE ]I ） were recorded and compared. The patients were grouped according to peak lac- tate level,and the lactate clearance rate at 8 h or 24 h,the duration of high lactate,the differences in their general information,APACHE l] score,mortality at 7 d and 28 d were compared. Result：The mortality of patients with lactate increase in ICU was significantly higher in 28d than in 7 d （33.08~ vsl8.05 %, P%0.01）. The peak lactate level,APACHE l] of 7 d,28 d in death group were significantly higher than that of survival group （P%0.05,0. 01）. The 8 h,24 h lactate clearance rate of the death group were significantly lower than that of survival group （P %0.01）. The 7 d mortality, APACHE II score of the severe lactic acidosis group were significantly higher than that of high lactate group （P%0. 01,0. 05）. But the 28 d mortality has no significant difference. There were no sta- tistically differences in 7 d and 28 d mortality,APACHE.l] score between the high lactate group and the lactic aci- dosis group. The 7 d and 28 d mortality of the high lactate clearance rate group were significantly lower than that of the low clearance rate group （P%0.01）. The 28 d mortality of the 24 h low clearance rate group was significant- ly higher than that of the 24 h secondary clearance rate group （P%0.01）. The 7 d,28 d mortality of high lactate〉 8 h group and 〉24 h group were significantly higher than of the %8 h group （P%0.01） ,and the 28 d mortality was significantly higher than 7 d mortality（P%0.05）. Conclusion： The overall mortality of 28 d of patients with lactate increase in ICU was significantly high than 7 d. The peak lactate level, lactate clearance rate, high lactate time are good indicators to evaluate patients prognosis. With the extension of the high lactate time,28 d mortalitywas significantly higher than 7 d-mortality, blood lactate level fell within normal limits in 8 h may improve the prognosis of critically ill patients.