碱剩余早期动态变化和乳酸清除率对脓毒症患者预后的评估

目的探讨碱剩余（BE）的动态变化和乳酸清除率对严重脓毒症和脓毒症休克患者预后的早期评估作用。方法回顾性分析149例严重脓毒症和脓毒症休克患者，根据入院后28d时结局分为存活组90例，死亡组59例，比较存活组和死亡组入院后动脉血碱剩余值及早期乳酸清除率，高、低碱剩余组，高、低乳酸清除率组间各参数比较，分析其与病死率、预后的关系；分析比较入院后开始3d碱剩余值均数与28d病死率间的关系。结果108例高BE组（BE≥-8mmol／L）患者的病死率为33．3％，显著低于41例低BE组（BE〈-8mmol／L）患者（56．1％，P〈0．05）。112例高乳酸清除率组（乳酸清除率≥10％）患者的病死率为34．8％，显著低于37例低乳酸清除率组（乳酸清除率〈10％）患者（54．1％，P〈0．05）。入院后开始3d碱剩余值均数与28d病死率间的相关分析示Pearson相关系数为0．946。结论高碱剩余组和高早期乳酸清除率组预后较好，治疗后碱剩余恢复较快组预后更好。

Values of base excess and early lactate clearance in assessment of prognosis of severe sepsis and septic shock

Objective To evaluate the values of base excess （BE） and early lactate clearance in assessment of prognosis of severe sepsis and septic shock. Methods 149 patients with severe sepsis and septic shock were divided into survival group （n=90） and death group （n=59） according to the outcome 28 days after admission without significant differences in age, sex, and APACH II score between these 2 groups at admission （all P〉 0.05）. The values of BE were measured 1, 2, 3, 4, 5, and 7 days after admission. The relations of the BE and early lactate clearance at admission with the prognosis were analyzed. Resu Its The mortality of the 108 patients with high BE （ ≥- 8 retool/L） was 38.3%, significantly lower than that of the 41 patients with low BE （〈 - 8 mmol/L）（56.1%, P〈0.05）. The mortality of the 112 patients with high lactate clearance （≥10%） was 34.8%, significantly lower than that of the 37 patients with low lactate clearance （〈10%）（54.1%, P〈0.05）. Correlatioin analysis to compare the mean valueof BE 3 days after admission and the mortality 28 days after admission showed a Perason correlation coefficient of 0.946. Cone I us i on The prognosis of the patients with high BE at admission is better than that of the patients with low BE, and the prognosis of the patients with high lactate clearance at admission is better than that of the patients with low lactate clearance at admission. The quicker the improvement of the abnormal BE value the better the prognosis.