乳酸清除率在脓毒性休克治疗中应用的临床意义

目的：研究乳酸清除率在脓毒性休克治疗中的临床意义。方法：我院ICU纳入严重脓毒症和脓毒性休克的患者155例。收集患者入院时的APACHEⅡ评分、入院时的血乳酸浓度及转归情况。根据患者转归情况分为存活组与死亡组并比较各项指标。以乳酸清除率10%为界分为高乳酸清除率组和低乳酸清除率组,并比较两组的病死率、APACHEⅡ评分和脓毒症休克发生率。结果：存活组休克发生率（24.42%）低于死亡组（84.06%）,两组比较,差异有高度统计学意义（χ2=27.53,P〈0.01）;而存活组乳酸清除率（33.27%）高于死亡组（14.26%）,两组比较,差异有高度统计学意义（χ2=21.60,P〈0.01）。高乳酸清除率组休克发生率（24.74%）低于低乳酸清除率组（84.50%）,两组比较,差异有高度统计学意义（χ2=29.38,P〈0.01）;高乳酸清除率组病死率（31.96%）低于低乳酸清除率组（82.80%）,两组比较,差异有高度统计学意义（χ2=31.16,P〈0.01）。结论：乳酸清除率在脓毒症的治疗和预后评估中具有实际临床意义,可作为脓毒性休克患者预后的主要判断依据之一。

Clinical significance of lactate clearance rate in the treatment of sepsis shock

Objective：To explore the clinical significance of lactate clearance rate in the treatment of sepsis shock.Methods：To observe and analyze the APACHE Ⅱ score,initial consistency of lactic acid and prognosis condition of the 155 patients in the Department of ICU in our hospital.They were diagnosised as serious sepsis and sepsis shock.According to the prognosis condition,155 patients were divided into two groups as survival group and death group,and compared in-dicators of them.According to lactate clearance rate 10%,155 patients were divided into two groups as high lactate cleaance rate group and low lactate clearance rate group.Lastly,the mortality rate,APACHE Ⅱ score and the incidence rate of sepsis shock were compared.Results：The incidence rate of shock of survival group（24.42%） was significantly different from that of death group（84.06%） which was significantly different（χ 2 =27.53,P0.01）.And the lactate clearance rate of survival group（33.27%） was obviously higher than death group（14.26%） which was significantly different（χ 2 =21.60,P0.01）.Mean-while,the incidence rate of shock of high lactate clearance rate group（24.74%）was significantly lower than that of low lactate clearance rate group（84.50%） which was significantly different（χ 2 =29.38,P0.01）.What＇s more,the mortality rate of high lactate clearance rate group（31.96%） was obviously lower than that of low lactate clearance rate group（82.80%） which was significantly different（χ 2 =31.16,P0.01）.Conclusion：Lactate clearance rate plays an important role as a significant prognosis judgment in sepsis shock treatment.