早期乳酸清除率及动脉血碱剩余水平对严重创伤患者的预后评估价值

目的探讨早期乳酸清除率及动脉血碱剩余水平对严重创伤患者的早期预后评估价值。方法 73例严重创伤患者根据患者28天转归及乳酸清除率分为存活组(47例)和死亡组(26例)、高乳酸清除率(≥10%)组44例和低乳酸清除率(<10%)组29例,收集入急诊重症监护室(EICU)时及治疗后6小时的肝素抗凝动脉血乳酸浓度,计算6 h乳酸清除率,入EICU时动脉血碱剩余,24 h急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,比较其差异的统计学意义。结果存活组患者乳酸清除率、动脉血碱剩余明显高于死亡组(P<0.05),24 h APACHEⅡ评分明显低于死亡组(P<0.05);高乳酸清除率组24 h APACHEⅡ评分与死亡率明显低于低乳酸清除率组(P<0.05),动脉血碱剩余高于低乳酸清除率组(P<0.05)。结论早期乳酸清除率联合动脉血碱剩余水平是判断严重创伤患者预后的一个较好指标。

Prognostic significance of early lactate clearance and base excess in patients with severe trauma

Objective To investigate the prognostic value of early lactate clearance and base excess in patients with severe trauma. Methods Seventy-three patients with severe trauma were divided into survival group （ n = 47 ） and death group （ n = 26 ） ac- cording to the outcome 28 days after admission. The high lactate clearance group （ n = 44 ） was defined as a lactate clearance t〉 10% within 6 hrs ,and the low lactate clearance rate group （n= 29 ） with a lactate clearance 〈 10%. The prognostic values of base excess, lactate clearance,and 24 hours＇ Acute Physiology and Chronic Health Evaluation ]] （ APACH II ） score were compared. Results The lactate clearance and base excess of survival group were significantly higher, and the 24 hours＇ APACHE II score was significantly lower than that of death group （ all P〈0.05 ）. With the low lactate clearance rate group, the high lactate clearance rate group had a lower 24 hours＇ APACH II score and a higher base excess （ P〈0.05 ）. Conclusion The early lactate clearance and base excess are very useful in predicting the outcome of patients with severe trauma.