动态监测血乳酸水平与感染性休克患者预后的关系

目的探讨动态监测血乳酸、乳酸清除率及APACHEⅡ评分与感染性休克患者预后的相关性。方法分析2011年7月—2013年10月该院收治的58例感染性休克患者动脉血乳酸水平的动态变化,将患者按预后分为死亡组与存活组,通过比较两组患者乳酸水平,乳酸清除率及APACHEⅡ评分,并通过比较不同乳酸水平及乳酸清除率组患者的临床资料来评价患者的预后。结果存活组与死亡组相比较,在年龄（t=2.645,P〈0.05）、初始乳酸（t=3.306,P〈0.05）、24 h乳酸清除率（t=-6.755,P〈0.05）、APACHEⅡ评分（t=5.538,P〈0.05）方面差异有统计学意义。高乳酸清除率组和低乳酸清除率组比较,两组在APACHEⅡ评分及初始乳酸值方面差异无统计学意义,而在死亡人数（χ2=4.852,P〈0.05）及年龄（t=2.093,P〈0.05）方面差异有统计学意义。结论动态监测血乳酸是判断感染性休克患者病情严重程度的指标,乳酸清除率及APACHEⅡ评分与患者的预后关系密切,对于高乳酸患者应尽早治疗,改善器官灌注及组织缺氧状态。

Correlation Between Dynamically Monitoring Blood Lactate Level and the Prognosis of Septic Shock Patients

Objective To discuss the relationship between dynamically monitoring blood lactate level,lactate clearance,Acute Physiology and Chronic Health Evaluation（APACHE Ⅱ） and the prognosis of patients with septic shock.Methods The dynamic changes of arterial blood lactate level of 58 cases with septic shock admitted in our hospital from July 2011 to October 2013 were analyzed.The patients were divided into the death group and the survival group.And the prognosis of the patients was evaluated by comparing blood lactate level,lactate clearance rate,APACHEⅡ score of the patients in the two groups,and the clinical data of patients with different blood lactate level and lactate clearance rate.Results The differences in age（t=2.645,P〈0.05）,initial lactate level（t=3.306,P〈0.05） and 24 hours lactate clearance rate（t=-6.755,P〈0.05） and APACHEⅡ（t=5.538,P〈0.05） between the survival group and death group were statistically significant.The differences in number of deaths（χ2=4.852,P〈0.05） and age（t=2.093,P〈0.05） between patients with low lactate clearance rate group and those with high lactate clearance rate group were statistically significant,while the differences in APACHEⅡ and initial lactate level between the two groups were not.Conclusion Dynamically monitoring the blood lactate level is an indicator for evaluating the condition of the patients with septic shock.Lactate clearance rate and APACHEⅡ are closely related to the prognosis of the patients with septic shock.Patients with high blood lactate level should be treated as soon as possible for improving the organ perfusion and tissue hypoxia.