早期乳酸清除率与ICU严重脓毒症和脓毒症休克患者预后相关性的研究

目的：探讨早期乳酸清除率与ICU严重脓毒症和脓毒症休克患者预后的相关性。方法：选择2009-01-2012-03入住我院内科ICU的231例严重脓毒症和脓毒症休克患者,按预后分为生存组（139例）和死亡组（92例）,比较2组患者早期不同时段血乳酸清除率及APACHE Ⅱ评分;比较严重脓毒症和脓毒症休克患者早期不同时段血乳酸清除率及APACHE Ⅱ评分;早期不同时段乳酸清除率与APACHE Ⅱ评分进行相关回归分析。结果：2组患者入院时血乳酸、入院后6h及12h乳酸清除率、入院后各时段APACHEⅡ评分比较,差异有显著的统计学意义（P〈0.05及〈0.01）,入院后24h、48h和72h乳酸清除率的差异无统计学意义（P〉0.05）;严重脓毒症和脓毒症休克患者入院后6h乳酸清除率的差异也有显著的统计学意义（P〈0.01）;入院后6h和12h乳酸清除率与同时段APACHEⅡ评分存在负性直线相关关系。结论：ICU严重脓毒症和脓毒症休克患者早期（入院后6h和12h）乳酸清除率对于判断其预后具有重要的临床意义。

Investigation on relationship between the lactate clearance rates and the prognosis in ICU patients with severe sepsis&septic shock

Objective：To explore the relationship between the lactate clearance rates and the prognosis in ICU patients with severe sepsis＆septic shock. Method： 231 ICU patients with severe sepsis＆septic shock from Jan. 2009 to Mar. 2012 were divided into survival group （139） and the non-survival group （92）. The two groups lactate clearance rates and APACHE Ⅱ score were compared at different time. Moreover,the relationship between lactate clearance rates and APACHE Ⅱ score was assessed by Logistic Regression Analyses. Result：There was a significant difference between survival group and non--survival group in the blood lactate on admission, the lactate clearance rates of 6 and 12 hours after admission and APACHE Ⅲ score at different time after admission （P〈0.05 or P〈0. 01）. There was no significant difference in the lactate clearance rates of 24,48 and 72 hours after admission be- tween the two groups（P〉0.05）. There was also a significant difference between patients with severe sepsis and septic shock in the lactate clearance rates of 6 hours after admission and APACHE Ⅱ score at different time after admission （P〈0.01）. The lactate clearance rates of 6 and 12 hours after admission were significantly correlated with APACHE Ⅱ score at the same time in those patients. Conclusion： The lactate clearance rates in early phase（6 and 12 hours after admission）were of important clinical value to the prognosis of ICU patients with severe sepsis＆septic shock.