血乳酸清除率及降钙素原与感染性休克患者预后相关性研究

目的 研究血乳酸清除率与降钙素原(PCT)与感染性休克患者预后相关性.方法 对医院2010年6月一2011年6月ICU收治的182例感染性休克患者血乳酸清除率与降钙素原与预后相关性进行研究,观察患者入院后第1、2、4天及转出ICU或死亡前的降钙素原变化和血乳酸清除率,按预后分组,转出ICU的112例患者为生存组,70例死亡患者为死亡组.结果 患者进入ICU第1天PCT检测结果差异无统计学意义,从第2天起,生存组PCT检测结果开始明显下降,直至转出前均呈下降趋势,而死亡组自第2天开始PCT检测结果较之前明显升高,而且呈逐渐上升趋势,两组比较差异有统计学意义(P＜0.05);生存组血乳酸清除率为(27.82±4.9)％；死亡组为(9.3±2.8)％；两组比较差异有统计学意义(P＜0.05).结论 降钙素原持续高水平提示病情危重,血乳酸清除率是氧代谢和全身灌注的重要指标,血乳酸的升高可直接反映低灌注情况下无氧代谢的增加,两项指标联合检测可作为对感染性休克患者预后判断的主要指标.

Correlation between clearance rate of blood lactate,procalcitonin and prognosis of septic shock

OBJECTIVE To study the correlation between the clearance rate of blood lactate,procalcitonin and the of prognosis of the patients with septic shock.METHODS A total of 182 patients with septic shock in the ICU in hospital from Jun 2010 to Jun 2011 were taken for research on the correlation between the clearance rate of blood lactate,procalcitonin and the prognosis.The procalcitonin changes and blood lactate clearance rate 1 day,2 days and 4 days after the admission and transferred out of ICU and before the death were observed.According to prognosis group,112 cases that transferred out of ICU were set as the survival group,70 patients who died were set as the death group.RESULTS The PCT test results for the first day of ICU admission in patients had no significant difference;the test results of PCT from the next day for the survival group decreased significantly,with a declining trend until the roll-out.The PCT test results for the death group from the second day was significantly higher than before,with the gradual upward trend.The difference between the two groups was significant(P<0.05).The clearance rate of blood lactate for the survival group was(27.82±4.9)%,the death group(9.3±2.8)%.The differences between the two groups were significant(P<0.05).CONCLUSION The continued high levels of procalcitonin prompt critical condition.The clearance rate of blood lactate is an important indicator of oxygen metabolism and systemic perfusion.The increasing of the blood lactate may be a direct reflection of the increasing of anaerobic metabolism under low perfusion.The two indicators of joint detection may be as the key indicators for patients with septic shock prognosis.