乳酸清除率联合碱剩余对严重脓毒症目标性治疗效果及预后的评估

目的探讨乳酸清除率联合碱剩余对严重脓毒症目标性治疗效果及预后评估的价值。方法回顾性分析天津医科大学第二医院ICU2006年1月至2009年1月临床资料完整的60例严重脓毒症患者,根据28 d转归分为生存组38例,死亡组22例,比较目标性治疗6 h后生存组与死亡组患者乳酸、碱剩余、乳酸清除率、6 h和48 h急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,将目标性治疗6 h后碱剩余及乳酸清除率与48 h APACHEⅡ评分进行相关分析。结果经目标性治疗6 h后生存组患者乳酸清除率明显高于死亡组(P<0.05),碱剩余亦明显高于死亡组(P<0.05),而血乳酸和入院6 h APACHEⅡ评分生存组与死亡组无统计学意义(P>0.05),6 h的碱剩余及乳酸清除率与48 h APACHEⅡ评分均具有相关性(P<0.05)。结论乳酸清除率联合碱剩余可以评估严重脓毒症目标性治疗的疗效和判断预后。

The Values of Combing Base Excess and Lactate Clearance in Assessment of Goal-directed Therapy and Prognosis of Severe Sepsis

Objective To investigate the values of combing base excess and lactate clearance in assessment of goal-directed therapy and prognosis of severe sepsis.Methods According to the outcome 28 days after admission,retrospectively analyze the 60 patients with severe sepsis and whole date,which were divided into survival group(n=38)and death group(n=22),the lactate,buffuer excess,lactate clearance,6 and 48 hoursacute physiology and chronic health evaluation Ⅱ(APACH Ⅱ)score between 2 groups are compared,the relations of the base excess and lactate clearance to APACH Ⅱ score in 48 hours were analyzed.Results Base excess and 6 hours lactate clearance after admission between 2 groups has statistical signification(P<0.05).There are relativity between the base excess,lactate clearance and APACH Ⅱ score in 48 hours(P<0.05).Conclusion Combing base excess and lactate clearance can evaluate the effect of directed therapy and the prognosis of severe sepsis.