重症脓毒症患者动态监测血乳酸的预后价值

目的：探讨动脉乳酸及乳酸清除率动态监测在重症脓毒症患者预后的临床应用价值。方法：据患者预后分为入ICU存活组和死亡组,比较两组动脉乳酸及6 h乳酸清除率,据APACHEⅡ分为≤20分组及〉20分组,比较两组入ICU动脉乳酸、6 h动脉乳酸及6 h乳酸清除率;用Spearman相关分析APACHEⅡ评分与入ICU动脉乳酸、6 h动脉乳酸及6 h乳酸清除率的相关性。结果：入ICU乳酸水平和6 h乳酸水平存活组明显低于死亡组水平（t=12.44、9.23,P〈0.01）,6 h乳酸清除率死亡组明显低于存活组（t=11.83,P〈0.01）;在APACHEⅡ评分≤20分组患者入ICU乳酸和6 h乳酸水平明显低于APACHEⅡ评分〉20分组患者水平（t=11.37、8.34,P〈0.01）,并且6 h乳酸水平≤20分组明显低于〉20分组水平（t=8.34,P〈0.01）,而6 h乳酸清除率≤20分组明显高于〉20分组水平（t=11.19,P〈0.01）。进一步分析结果显示,入ICU乳酸水平与APACHEⅡ评分呈显著正相关（r=0.734,P〈0.01）;6 h乳酸水平与APACHEⅡ评分呈显著正相关（r=0.698,P〈0.01）;而6 h乳酸清除率与APACHEⅡ评分呈显著负相关（r=-0.632,P〈0.01）。结论：动态监测动脉乳酸水平是判断重症脓毒症患者预后和病情严重程度的一个良好指标,动脉乳酸越高,病情越重,预后差。

The prognostic value of dynamic monitoring blood lactate of patients with severe sepsis

Objective：To investigate clinical value of the level of arterial lactic acid and the rate of lactate clearance in predicting the prognosis of patients with severe sepsis.Methods：According to the prognosis of patients,the patients were divided into survival group and death group,arterial lactic acid level and 6 h lactate clearance rate in the two groups were compared.According to APACHEⅡ score,the patients were divided into ≤20 and 〉20 group,the arterial lactate into the ICU,6 h arterial lactic acid and lactate clearance rate were compared.The correlation of APACHEⅡ score and arterial lactate into the ICU,6 h arterial lactic acid and lactate clearance rate were analyzed by Spearman correlation analysis.Results：The level of lactic acid into the ICU and 6 h lactate levels of survival were significantly lower than those of the death group（t=12.44,9.23,P〈0.01）,and 6 h lactate clearance rate death group was significantly lower than that of the of the survival group（t=11.83,P〈0.01）;in the APACHEⅡ score ≤20 group,lactic acid into the ICU levels and 6 h lactic acid levels were significantly lower than those of the APACHEⅡ score 〉20 group（t=11.37,8.34,P〈0.01）,and 6 h lactate levels of ≤20 group were significantly lower than 〉20 group（t=8.34,P〈0.01）,and 6 h lactate clearance rate of the ≤20 group was significantly higher than that of 〉20 group（t=11.19,P〈0.01）.Further analysis showed that the lactate level into the ICU and APACHEⅡ score was significantly positively correlated（r=0.734,P〈0.01）;6 h lactate levels and APACHEⅡ score was significantly positively correlated（r=0.698,P〈0.01）;and 6 h lactate clearance rate and APACHEⅡ score was significant negative correlation（r=-0.632,P〈0.01）.Conclusion：Dynamic monitoring of arterial lactate levels is a good indicator to determine the prognosis of patients with severe sepsis,the higher arterial lactate,the more severe disease and poor prognosis.