早期血乳酸清除率在评估外科休克预后中的临床意义

目的探讨早期血乳酸清除率在评估外科休克患者预后中的临床意义。方法检测104例外科休克患者0h（以诊断休克为研究起点）、6h动脉血乳酸水平,计算6h乳酸清除率。以痊愈出院或死亡为研究终点,按预后不同将患儿分为存活组（n=85）和死亡组（n=19）;以乳酸清除率10%为界分为高乳酸清除率组（≥10%,n=81）和低乳酸清除率组（〈10%,n=23）,比较存活组与死亡组、高乳酸清除率组与低乳酸清除率组之间相关数值的差异。结果存活组6h血乳酸清除率为（19.0±10.1）%,显著高于死亡组（[7.4±3.3）%,P〈0.01];高乳酸清除率组多器官功能障碍综合征（MODS）发生率（1.2%;）、病死率（3.7%）均低于低乳酸清除率组（26.1%、69.6%）,均P〈0.01。存活组与死亡组、高乳酸清除率组与低乳酸清除率组0h动脉血乳酸水平差异均无统计学意义（均P〉0.05）;但6h血乳酸水平存活组低于死亡组,高乳酸清除率组低于低乳酸清除率组（均P〈0.01）。结论早期乳酸清除率可作为判断外科休克患者预后的一个指标。

Clinical significance of early lactate clearance rate in evaluating prognosis of patients with surgical shock

Objective To investigate the clinical significance of early arterial blood lactate clearance rate in evaluating the prognosis of patients with surgical shock.Methods 104 patients with surgical shock were detected for arterial blood lactate before treatment and 6 hours after the treatment,then the 6 h lactate clearance rate were calculated.According to the results of following up,the patients were divided into survival group(S-group,n=85) and non-survival group(NS-group,n=19).Based on lactate clearance rate(10% as limit),the patients were divided into high lactate clearance rate group(H-group,≥10%,n=81) and low lactate clearance rate group(L-group,<10%,n=23).Data were compared between the S-group and the NS-group,as well as between the H-group and the L-group.Results The 6 h lactate clearance rate of the S-group was(19.0±10.1)%,which was significantly higher than that of the NS-group(7.4±3.3)%,P<0.01.The incidence and mortality of multiple organ dysfunction syndrome(MODS) of the H-group(1.2%,3.7%) were lower than that of the L-group(26.1%,69.6%)(P<0.01).There were no statistically significant differences in arterial blood lactate before the treatment between the S-group and the NS-group or between the H-group and the L-group(P>0.05),while there were statistically significant differences between the groups 6 h after the treatment(P<0.01).Conclusion Early arterial blood lactate clearance rate serves as a good index for predicting the prognosis of patients with surgical shock.