动脉血乳酸水平及乳酸清除率评估感染性休克预后的意义

目的 评价动脉血乳酸及乳酸清除率评估感染性休克患者预后的意义.方法 记录64例急诊重症监护室(EICU)的感染性休克患者入住重症监护室(ICU)1h内、6h、12 h、24h、48 h的血乳酸浓度,并计算12 h时的乳酸清除率,根据治疗后的转归分成两组,存活组和死亡组.比较两组血乳酸水平及乳酸清除率.结果 存活组和死亡组人ICU时血乳酸浓度分别为(7.2±5.4) mmol/L和(9.2±5.6) mmoL/L,均大于正常.存活组6h后开始下降,24h为(2.2±1.3) mmol/L,基本正常；而死亡组48 h血乳酸浓度为(8.0±3.8) mmol/L,仍明显大于正常,直至死亡,两组差异有统计学意义(t=3.7816,3.8257,7.5263,4.5875,5.8765,P＜0.05).死亡组患者12 h时乳酸清除率(5.83±3.92) mmol/L]明显低于存活组(14.32±2.68) mmol/L](t=6.2565,P＜0.05).结论 动脉血乳酸浓度与感染性休克患者预后呈正相关,乳酸清除率动态反应病情进展,是判断危重病严重程度的早期、敏感、定量的指标.

The significance of blood lactic acid level and lactic acid clearance in evaluating the prognosis of septic shock

Objective To explore the significance of blood lactic acid level and lactic acid clearance in evaluating the prognosis of septic shock. Methods The blood lactic acid concentration of 64 patients with septic shock EICU ICU admission lh inside, 6, 12, 24 and 48h was recorded, and the lactic acid clearance was calculated 12 hours after treatment, and according to lactic acid clearance of outcome, 64 patients were divided into two groups, live group and death group;Then compared blood lactic acid level and lactic acid clearance between the two groups. Results The blood lactic acid concentration of live group and death group when enter the ICU was （7. 2 ± 5.4 ） mmol/L, （ 9.2± 5.6 ） mmol/L respectivly, and was higher than normal, and of live group after 6h began to fall, and it reached normal level after 24h （ 2.2± 1.3 ） mmol/L ], but of death group after 48h （ 8.0 ± 3.8 ） mmol/L] was still significantly higher than normal, until death. There was significant difference between the two groups （ t = 3. 7816,3. 8257,7. 5263,4. 5875,5. 8765 ,all P 〈0.05）. The lactic acid clearance of death group after 12 hours was （ 5.83 ±3.92） mmol/L, and significantly lower than that of live group （ 14.32 ± 2.68 ） mmol/L ] （ t = 6. 2565, P 〈 0. 05）. Conclusion Blood lactic acid concentration was positively related to the prognosis of patients with septic shock, and dynamic response of disease progression by detecting lactic acid clearance rate could be early, sensitive, quantitative indicators to determine the severity of critical illness.