乳酸清除率对重症脓毒血症患者的临床预后价值分析

选取2007年9月²013年9月在本院就诊的138例重症脓毒血症患者,测定初始动脉血乳酸、入院6h、24h、48h的动脉血乳酸乳酸和乳酸清除率。根据早期乳酸清除率将患者分为高乳酸清除率组(早期乳酸清除率≥10%)72例和低乳酸清除率组(早期乳酸清除率<10%)66例。根据预后情况,将患者分为存活组97例和死亡组41例。着重观察高乳酸清除率组和低乳酸清除率组患者的住院期间急性生理学及慢性健康状况评价Ⅱ(APACHEⅡ)评分、发生休克例数、MODS发生例数及死亡率。同时观察存活组与死亡组入院6、24、48h的乳酸清除率。结果高乳酸清除率组APACHEⅡ评分、休克发生率、MODS发生率及病死率均明显低于低乳酸清除率组,两组比较差异有统计学意义(P<0.05);存活患者97例,死亡患者41例,存活患者入院6、24、48h乳酸清除率均高于死亡患者,差异有统计学意义(P<0.05)。血乳酸清除率可反映重症脓毒血症患者的严重程度及预后情况,血乳酸清除率越低,病情越严重,预后越差。     

PICU脓毒血症患者血乳酸水平与小儿危重病例评分及预后相关性

目的:观察PICU收治脓毒血症患者动脉血乳酸水平与小儿危重病例评分及预后的相关性。方法:选择本院PICU 2012-01-2012-12入住PICU临床资料完整的75例脓毒血症患者作为研究对象进行回顾性分析。所有研究对象入住PICU后均抽取动脉血测定血乳酸,并行小儿危重病例评分,根据危重病例评分分值将研究对象分为3组,A组(80分~100分)、B组(70分~80分)和C组(0分~70分),分析血乳酸水平与小儿危重病例评分相关性。观察患者预后情况。结果:C组患者血乳酸水平明显高于B组患者(t=7.64,P0.01)、A组患者(t=9.14,P0.01);C组患者病死率明显高于B组患者(χ2=18.45,P0.01)、A组患者。死亡组患者的小儿危重病例评分分值明显低于存活组(t=2.85.P0.05),而血乳酸水平明显高于存活组(t=9.53,P0.05)。差异均有统计学意义。血乳酸水平与小儿危重病例评分显著相关(r=0.81,t=6.93,P0.01)。结论:通过动态监测评分与血乳酸水平发现,随着小儿危重病例评分下降,血乳酸浓度相应增高;血乳酸浓度与病情严重程度正相关,是病情严重程度的早期、敏感、定量的指标。     

老年脓毒血症患者胆碱酯酶水平与病情及预后的关系

目的探讨脓毒血症患者胆碱酯酶水平与患者病情及预后的关系。方法 2007年6月-2009年6月,将89例脓毒血症患者设定为脓毒血症组,进行血清胆碱酯酶测定及APACHEⅡ评分;另择82例健康人为正常组,测定血清胆碱酯酶值,比较两者之间差异;89例脓毒症患者按病况再分为存活组及死亡组,比较两者之间血清胆碱酯酶及APACHEⅡ评分差异。结果治疗前脓毒血症组胆碱酯酶水平明显低于正常组,有统计学意义（P〈0.01）;脓毒血症组APACHEⅡ评分与血清胆碱酯酶呈负相关;死亡组APACHEⅡ评分明显高于存活组,而血清胆碱酶低于存活组（P〈0.01）。结论胆碱酯酶同APACHEⅡ评分呈负相关,能明显反映脓毒症患者病情严重程度及预后。     

脓毒血症患者外周血白细胞凋亡与病情及预后关系

目的通过检测脓毒血症患者外周血淋巴细胞、中性粒细胞凋亡率,以阐述白细胞凋亡在脓毒血症患者中的作用机制及其与病情及预后的关系。方法采用流式细胞仪分别测定44例脓毒血症患者外周血淋巴细胞和中性粒细胞凋亡率,与健康对照组比较,并分析其与病情及预后的关系。结果脓毒血症组淋巴细胞凋亡率明显高于对照组〔(13.06±3.23)%vs(2.85±1.19)%,P<0.05〕,而中性粒细胞凋亡率明显低于对照组〔(3.18±0.65)%vs(3.92±0.74)%,P<0.05〕。进一步分析显示,病情严重者及病情进展组分别与病情较轻者和病情好转组比较,淋巴细胞凋亡明显增强,而中性粒细胞凋亡受抑。结论脓毒血症患者存在淋巴细胞凋亡增强,中性粒细胞凋亡延缓,可能在其发病机制中具有重要作用,并且与疾病严重程度及预后相关。     

糖皮质激素抵抗与脓毒血症

1　脓毒血症的近代认识与治疗　　脓毒血症是指由感染因素所导致的全身炎症反应综合征 (SIRS) ,在感染为诱因的前提下 ,脓毒血症与 SIRS同义 〔1 ,2〕,即在受到损伤的过程中 ,机体不仅是受害者 ,而且是积极的参与者。脓毒血症是严重创伤、烧伤、休克、感染、外科大手术后的常见并发症 ,可发展为脓毒性休克和多器官功能障碍综合征(MODS) ,已成为临床危重病患者的主要死亡原因之一。目前认为 ,脓毒血症、脓毒性休克、MODS反映了体内一系列病理生理改变及临床病情严重程度的动态过程 ,其实质是机体全身炎症反应不断加剧、持续恶化 ,其中…     

脓毒血症患者血清PCT、内毒素、CRP水平与病原菌及预后的关系分析CSCD

目的探讨脓毒血症患者血清降钙素原(PCT)、内毒素、C反应蛋白(CRP)水平与病原菌及预后的关系。方法回顾性分析2020年1月~2021年1月收治的74例经血培养确诊脓毒血症患者的临床资料。根据血培养结果分为革兰氏阴性菌组(46例)、革兰氏阳性菌组(28例);根据住院第28d预后情况分为生存组(55例)、死亡组(19例)。对比革兰氏阴性菌组与革兰氏阳性菌组患者、生存组与死亡组患者血清PCT、内毒素、CRP水平。采用Spearman相关分析血清PCT、内毒素、CRP水平和脓毒血症患者病原菌种类的相关性。采用受试者工作特征曲线分析血清PCT、内毒素、CRP水平对脓毒血症患者预后的预测价值。结果革兰氏阴性菌组患者血清PCT、内毒素、CRP水平[(3.79±0.57)ng/ml、(0.60±0.13)ng/L、(36.35±4.59)mg/L]明显高于革兰氏阳性菌组[(1.72±0.46)ng/ml、(0.18±0.04)ng/L、(18.42±3.14)mg/L]患者(t=16.251、16.585、18.215,P均<0.001),预后差于革兰氏阳性菌组患者(死亡率:34.78%比10.71%,χ^(2)=5.284,P=0.022)。死亡组患者血清PCT、内毒素、CRP水平[(3.41±0.74)ng/ml、(0.55±0.12)ng/L、(35.76±7.21)mg/L]明显高于生存组[(2.34±0.59)ng/ml、(0.38±0.11)ng/L、(27.41±5.08)mg/L]患者(t=6.374、5.674、5.517,P均<0.001)。Spearman相关分析显示:脓毒血症患者血清PCT、内毒素、CRP水平均与病原菌类型呈负相关(r=-0.785、-0.793、-0.822,P均<0.001)。ROC曲线显示:血清PCT、内毒素、CRP水平对脓毒血症患者预后具有一定预测价值(AUC=0.862、0.831、0.827,P均<0.001),且3项联合(AUC=0.911,P<0.001)预测价值较高。结论PCT、内毒素、CRP在革兰氏阴性菌感染所致脓毒血症患者血清中表达明显高于革兰氏阳性菌感染所致脓毒血症患者,3项指标联合检测可作为预测脓毒血症患者预后的辅助手段。     

感染性休克患儿的血脂变化与预后关系的探讨

目的 探讨血脂在感染性休克患儿血中的变化与预后的关系。方法 选择符合诊断标准的感染性休克患儿32例（其中存活者19例，死亡者13例）作为实验组，检测确定诊断后第2天晨起空腹血的血脂水平，并选择同年龄组健康体检者15例的晨起空腹血脂水平作为对照，进行前瞻性研究。结果 感染性休克患儿的血脂（血总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇）与对照组相比差异有统计学意义（P〈0．01）。感染性休克组的血脂比对照组低；感染性休克组存活者和死亡者的血胆固醇相比差异有统计学意义（P〈0.01）。死亡者比存活者血胆固醇要低，而血三酰甘油差异无统计学意义。结论 感染性休克患儿的血脂水平与预后有关，血胆固醇越低，预后越差。     

脓毒血症13例临床护理

对2007年10月～2009年12月,在我院住院治疗的脓毒血症患者13例进行前瞻性分析,总结护理效果和经验.经治疗护理后,痊愈11例,死亡2例,抢救成功率为84.61%.提示全面的护理是救治脓毒血症的重要环节,对促进患者康复具有重要的意义.     

肺炎患儿血浆乳酸水平与预后的相关性分析

目的:探讨肺炎患儿血浆乳酸水平与预后的相关性.方法:以2008年8月-2010年8月收治的普通肺炎和重症肺炎为对照组(n＝100)和观察组(n＝100),健康儿童为正常组(n＝50)比较其血浆乳酸.结果:急性期观察组血浆乳酸水平明显高于对照组 (P＜0.05),恢复期两组血浆乳酸水平无明显差异;血浆乳酸水平升高与病情严重度呈正相关(P＜0.05).结论:血浆乳酸水平的测定有助于早期、准确地判断肺炎患儿病情严重程度及转归.     

动脉血乳酸浓度与感染性休克患者的预后关系分析

目的研究动脉血乳酸浓度与感染性休克患者预后的关系。方法将52例感染性休克患者根据预后不同分为存活组和死亡组,比较2组患者动脉血乳酸水平和血气分析检测结果。结果 2组患者入重症监护室(ICU)后动脉血乳酸水平均显著高于正常范围,随着治疗开始逐渐降低;存活组患者入ICU后0、6、12、24及48 h时动脉血乳酸水平均显著低于死亡组;死亡组患者入ICU后48 h时动脉血乳酸水平再次升高;存活组患者6 h乳酸清除率显著高于死亡组。动脉血气分析结果显示,存活组患者的氧分压(PO2)及急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分显著低于死亡组,而平均动脉压(MAP)显著高于死亡组。结论预后不良的感染性休克患者动脉血乳酸多处于较高水平,入住ICU后6 h的乳酸清除率较低的患者预后也相对更差。     

重症儿童脓毒症患儿血乳酸动态变化特点及死亡危险因素分析

目的分析儿童重症脓毒症血乳酸动态变化特点及死亡危险因素。方法选取87例重症脓毒症患儿为脓毒症组,在入院时及入院6、12、24、48 h通过血气分析仪测定血乳酸水平,选择同期健康体检60例正常儿童为对照组,比较各组血乳酸水平。根据预后将患者分为死亡组与存活组,单因素及Logistic多因素回归分析患儿死亡危险因素。结果脓毒症组入院时血乳酸水平显著高于对照组(P0.05),有MODS患儿血乳酸水平显著高于无MODS者(P0.05)。死亡组入院时及入院6、12、24、48 h血乳酸水平均显著高于存活组(P0.05),死亡组PCIS评分、白蛋白水平、MODS发生率、MODS受累脏器数、休克、静脉糖皮质激素使用率与存活组比较有显著差异(P0.05)。Logistic多因素回归分析显示,导致患儿死亡的独立危险因素为PCIS评分、MODS受累脏器数、休克、血乳酸水平、白蛋白水平。结论血乳酸水平动态监测对儿童重症脓毒症病情判断、预后评估有重要意义。     

血乳酸水平及清除率和升高时间与重症监护病房危重患者预后的关系

目的 探讨乳酸动态监测指标与重症监护病房(ICU)危重患者预后的相关关系,并对这种关系进行量化评价.方法 收集101例乳酸升高的危重患者,分为死亡组(50例)和存活组(51例),比较两组的乳酸监测指标(乳酸水平、乳酸升高时间、乳酸清除率)、急性生理学与慢性健康状况评分系统Ⅰ(APACHE Ⅰ)评分及其他反映器官功能的指标,使用logistic回归分析找出与预后显著相关的指标.以相应的乳酸指标进行量化分组,分别比较各组休克和多器官功能障碍综合征(MODS)发生率、APACHE Ⅰ评分和病死率.结果 死亡组入ICU乳酸值、乳酸峰值、APACHE Ⅰ评分高于存活组,12 h和24 h乳酸清除率、pH值低于存活组(P<0.05或P<0.01).乳酸峰值、12 h乳酸清除率、APACHE Ⅰ评分和pH值与患者的预后明显相关,相对比值比(OR)分别为1.466、0.922、1.208、0.032.乳酸峰值≥10 mmol/L、12 h乳酸清除率≤10%的患者病死率明显升高,分别为77.8%和70.6%(P<0.05和P<0.01),乳酸升高时间>24 h时病死率虽升高,但无统计学意义.结论 乳酸峰值、12 h乳酸清除率、APACHE Ⅰ评分和pH值是评价患者预后的良好指标.乳酸峰值≥10 mmol/L、12 h乳酸清除率≤10%时应警惕患者较差的预后,而乳酸升高时间评价预后的价值有限.     

脑梗死患者血尿酸与血脂及颈动脉斑块形成的关系

目的探讨脑梗死（CI）患者血清尿酸（UA）与血脂及颈动脉硬化斑块之间的关系。方法分别测定98例CI患者及49例体检健康者血清UA和血脂浓度,并对其中78例CI患者进行颈动脉超声检查。结果 CI组的血清UA为（310.88±90.91）μmol/L,显著高于对照组（266.96±55.04）μmol/L（P=0.000）;CI患者的年龄和血清UA水平与颈动脉硬化斑块的形成呈明显正相关;甘油三酯和总胆固醇均升高的患者血清UA水平高于血脂正常、单纯高甘油三酯和单纯高总胆固醇的患者（均P〈0.05）。结论血清UA升高与CI密切相关,其与患者血脂水平和颈动脉硬化斑块的形成有关,可作为诊断CI和颈动脉斑块形成的参考指标。     

1110名民航飞行员血尿酸与血脂血糖和血压的关系

目的探讨民航飞行员人群中高尿酸发病率及其与血脂、血糖和血压之间的相互关系及其临床意义。方法收集2009年12月至2010年12月1 100名民航飞行员的体检资料,用统计学方法分析其高血尿酸患病率特点及其与及其与血脂、血糖和血压之间的相互关系。结果在各年龄组中,高尿酸血症的分布呈现先高后低的规律,其峰值出现在36~40岁组占39.05%,且高尿酸组的高血脂患病率为37.12%、高血糖患病率为25.00%及高血压患病率为29.92%,均明显高于正常血尿酸组的13.24%、15.01%、16.08%,差异有统计学意义(P<0.01)。结论民航飞行员年龄在36~40岁时,其血尿酸的水平最高,且高血尿酸与高血脂、高血糖及高血压呈正相关。应该注意防护。     

成年男性血红蛋白水平升高与空腹血糖、血尿酸及血脂检测结果分析

目的探讨进行健康体检的成年男性血红蛋白(Hb)水平升高与其空腹血糖(FBG)、血尿酸(UA)及血脂[三酰甘油(TG)与总胆固醇(TC)]检测结果。方法将2018年10-11月1 007例Hb升高的成年男性按Hb水平不同分为A1、A2、A3、A4、A5组,另选取同期85例Hb水平正常体检者作为对照组,对所有研究对象FBG、UA及血脂水平进行检测,并对检测结果进行分析。结果 A1、A2、A3、A4、A5组FBG、UA及血脂水平均值及异常百分数均高于对照组,差异均有统计学意义(P<0.05)。均值比较:A1、A2、A3、A4、A5组血脂及A3组UA水平与对照组比较,差异均有统计学意义(P<0.05);A1组与A3组UA与TG水平比较,差异均有统计学意义(P<0.05),其他各组UA与TG水平比较,差异均无统计学意义(P>0.05);异常百分数比较:除A1、A2、A3、A4、A5组TG,A1、A2、A3、A4组TC与对照组及A1组与A4组FBG与TC差异有统计学意义(P<0.05)外,其余组间比较,差异均无统计学意义(P>0.05)。结论成年男性Hb水平升高与其生化项目FBG、UA及血脂的变化有一定相关性,与FBG不存在统计学上的差异,但整体呈上升趋势,对非传染性流行病有辅助诊断价值。     

血乳酸水平及清除率和升高时间与重症监护病房危重患者预后的关系

Objective To study and quantify the relationship between dynamic lactic acid monitoring indexes and prognosis of critically ill patients in intensive care unit (ICU). Methods One hundred and one critically ill patients with elavated blood lactic acid level were included in this study and divided into death group (n= 50) and survival group (n = 51). Differences in their lactic acid indexes (including: lactic acid level, duration of lacticemia, lactic clearance), acute physiology and chronic health evaluation Ⅰ (APACHE Ⅰ ) score, and other clinical indicators which reflected organ/system status were compared, and prognostic significant lacticemia indexes were formulated by multi-variable logistic analysis. Subsequently, patients were grouped by significant lactic indexes separately and compared with incidence of shock/multiple organ dysfunction syndrome (MODS), APACHE Ⅰ score and mortality. Results Differences in lactic acid level, peak lactic acid level, 12-hour and 24-hour lactic acid clearance between death group and survival group showed statistically significant difference (P<0. 05 or P<0. 01). Peak lactic acid level, 12-hour lactic clearance, APACHE Ⅰ score and blood pH had significant correlation with prognosis, odds ratios (OR) were 1. 466, 0. 922, 1. 208, 0. 032, respectively. Patients with peak lactic acid value≥10 mmol/L or 12-hour lactic clearance≤10% had significantly higher mortality: 77. 8% and 70. 6%, respectively (P<0. 05 and P< 0.01). Although patients with lacticemia > 24 hours had higher mortality, there was no statistically significant difference. Conclusion Peak lactic acid level, 12-hour lactic clearance, APACHE Ⅰ score and blood pH are good indicators to evaluate patients' prognosis. Peak lactic acid value≥10 mmol/L or 12-hour lactic clearance≤10% is an alert of extremely bad prognosis. Prognosis value of duration of lacticemia is limited.     

血乳酸水平及清除率和升高时间与重症监护病房危重患者预后的关系

Objective To study and quantify the relationship between dynamic lactic acid monitoring indexes and prognosis of critically ill patients in intensive care unit (ICU). Methods One hundred and one critically ill patients with elavated blood lactic acid level were included in this study and divided into death group (n= 50) and survival group (n = 51). Differences in their lactic acid indexes (including: lactic acid level, duration of lacticemia, lactic clearance), acute physiology and chronic health evaluation Ⅰ (APACHE Ⅰ ) score, and other clinical indicators which reflected organ/system status were compared, and prognostic significant lacticemia indexes were formulated by multi-variable logistic analysis. Subsequently, patients were grouped by significant lactic indexes separately and compared with incidence of shock/multiple organ dysfunction syndrome (MODS), APACHE Ⅰ score and mortality. Results Differences in lactic acid level, peak lactic acid level, 12-hour and 24-hour lactic acid clearance between death group and survival group showed statistically significant difference (P<0. 05 or P<0. 01). Peak lactic acid level, 12-hour lactic clearance, APACHE Ⅰ score and blood pH had significant correlation with prognosis, odds ratios (OR) were 1. 466, 0. 922, 1. 208, 0. 032, respectively. Patients with peak lactic acid value≥10 mmol/L or 12-hour lactic clearance≤10% had significantly higher mortality: 77. 8% and 70. 6%, respectively (P<0. 05 and P< 0.01). Although patients with lacticemia > 24 hours had higher mortality, there was no statistically significant difference. Conclusion Peak lactic acid level, 12-hour lactic clearance, APACHE Ⅰ score and blood pH are good indicators to evaluate patients' prognosis. Peak lactic acid value≥10 mmol/L or 12-hour lactic clearance≤10% is an alert of extremely bad prognosis. Prognosis value of duration of lacticemia is limited.     

血乳酸水平及清除率和升高时间与重症监护病房危重患者预后的关系

Objective To study and quantify the relationship between dynamic lactic acid monitoring indexes and prognosis of critically ill patients in intensive care unit (ICU). Methods One hundred and one critically ill patients with elavated blood lactic acid level were included in this study and divided into death group (n= 50) and survival group (n = 51). Differences in their lactic acid indexes (including: lactic acid level, duration of lacticemia, lactic clearance), acute physiology and chronic health evaluation Ⅰ (APACHE Ⅰ ) score, and other clinical indicators which reflected organ/system status were compared, and prognostic significant lacticemia indexes were formulated by multi-variable logistic analysis. Subsequently, patients were grouped by significant lactic indexes separately and compared with incidence of shock/multiple organ dysfunction syndrome (MODS), APACHE Ⅰ score and mortality. Results Differences in lactic acid level, peak lactic acid level, 12-hour and 24-hour lactic acid clearance between death group and survival group showed statistically significant difference (P<0. 05 or P<0. 01). Peak lactic acid level, 12-hour lactic clearance, APACHE Ⅰ score and blood pH had significant correlation with prognosis, odds ratios (OR) were 1. 466, 0. 922, 1. 208, 0. 032, respectively. Patients with peak lactic acid value≥10 mmol/L or 12-hour lactic clearance≤10% had significantly higher mortality: 77. 8% and 70. 6%, respectively (P<0. 05 and P< 0.01). Although patients with lacticemia > 24 hours had higher mortality, there was no statistically significant difference. Conclusion Peak lactic acid level, 12-hour lactic clearance, APACHE Ⅰ score and blood pH are good indicators to evaluate patients' prognosis. Peak lactic acid value≥10 mmol/L or 12-hour lactic clearance≤10% is an alert of extremely bad prognosis. Prognosis value of duration of lacticemia is limited.     

血乳酸水平及清除率和升高时间与重症监护病房危重患者预后的关系

Objective To study and quantify the relationship between dynamic lactic acid monitoring indexes and prognosis of critically ill patients in intensive care unit (ICU). Methods One hundred and one critically ill patients with elavated blood lactic acid level were included in this study and divided into death group (n= 50) and survival group (n = 51). Differences in their lactic acid indexes (including: lactic acid level, duration of lacticemia, lactic clearance), acute physiology and chronic health evaluation Ⅰ (APACHE Ⅰ ) score, and other clinical indicators which reflected organ/system status were compared, and prognostic significant lacticemia indexes were formulated by multi-variable logistic analysis. Subsequently, patients were grouped by significant lactic indexes separately and compared with incidence of shock/multiple organ dysfunction syndrome (MODS), APACHE Ⅰ score and mortality. Results Differences in lactic acid level, peak lactic acid level, 12-hour and 24-hour lactic acid clearance between death group and survival group showed statistically significant difference (P<0. 05 or P<0. 01). Peak lactic acid level, 12-hour lactic clearance, APACHE Ⅰ score and blood pH had significant correlation with prognosis, odds ratios (OR) were 1. 466, 0. 922, 1. 208, 0. 032, respectively. Patients with peak lactic acid value≥10 mmol/L or 12-hour lactic clearance≤10% had significantly higher mortality: 77. 8% and 70. 6%, respectively (P<0. 05 and P< 0.01). Although patients with lacticemia > 24 hours had higher mortality, there was no statistically significant difference. Conclusion Peak lactic acid level, 12-hour lactic clearance, APACHE Ⅰ score and blood pH are good indicators to evaluate patients' prognosis. Peak lactic acid value≥10 mmol/L or 12-hour lactic clearance≤10% is an alert of extremely bad prognosis. Prognosis value of duration of lacticemia is limited.