监测动脉血乳酸水平对评估重症肺炎患者病情的临床意义

目的探讨监测动脉血乳酸水平对评估重症肺炎患者病情的临床意义。方法回顾性分析2009年6月-2011年6月因重症肺炎入住ICU的42例患者,分别对治疗前和治疗后6,12,24,72,120h的动脉血乳酸水平进行监测并同步行APACHEII评分。比较治疗后120h和治疗前血乳酸水平,将患者分为乳酸升高组(20例)和乳酸降低组(22例),测定2组患者治疗后120h的动脉血氧分压,计算氧合指数,统计入住ICU的时间及总费用,并进行对比。结果治疗前,乳酸升高组和降低组的动脉血乳酸水平分别为(9.6±5.2)和(9.8±6.2)mmol/L,APACHEⅡ评分分别为(22.3±3.2)和(24.0±3.1)分,2组比较差别均无统计学意义(P>0.05);治疗后120h,乳酸升高组和降低组动脉血乳酸水平分别为(14.5±6.1)和(8.9±5.1)mmol/L,APACHEⅡ评分分别为(26.2±2.9)和(22.5±3.4)分,2组比较差别均有统计学意义(P<0.05),且动脉血乳酸水平愈低,APACHEⅡ评分愈低,两者具有相关性(r=0.679,P<0.05)。结论监测动脉血乳酸水平对于评估重症肺炎患者的病情有重要意义。

Clinical Disease Assessment Significance of Monitoring of Arterial Blood Lactate Levels in Patients with Severe Pneumonia

ObjectiveTo study the clinical disease assessment significance of monitoring of arterial blood lactate levels in patients with severe pneumonia.MethodsIn 42 severe pneumonia patients,the arterial blood lactate levels,oxygenation index,PaO2 were measured before the treatment and 6,12,24,72,120 hours after the treatment.At the same time,the scores of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),the days and the cost of hospitalization were evaluated.According to the contrast of the arterial blood lactate levels between the two groups 120 hours after the treatment,the 42 severe pneumonia patients were divided into lower arterial blood lactate levels group and elevated arterial blood lactate levels group,and the group differences were analyzed.ResultsThe arterial blood lactate levels of the elevated group and lower group were(9.6±5.2)mmol/L and(9.8±6.2)mmol/L respectively;APACHEⅡ were(22.3±3.2) and(24.0±3.1) respectively(P>0.05).The arterial blood lactate levels in lower group is significantly lower than elevated group,and the higher the APACHEⅡ are,the higher the arterial blood lactate levels are.Afer effectie treatment,the arterial blood lactate levels significantly lower the same as the APACHEⅡ.There is the dependablity between them(r=0.679,P<0.05).ConclusionThe monitoring of arterial blood lactate levels to be contributive to assess the condition of the patients with sever pneumonia.