早期乳酸清除率对多发伤患者预后的评估

目的探讨早期乳酸清除率对多发伤患者的预后评估价值。方法回顾性分析经积极治疗的57例多发伤患者，收集治疗前、后6h的中心静脉全血乳酸浓度，计算6h乳酸清除率，并与24hAPACHEⅡ评分作相关性比较。结果（1）将乳酸清除率以50％和25％为界分为三组，三组患者病死率和多脏器功能不全（MODS）发生率比较，差异有显著统计学意义（0vs4％vs33．33％和8．70％峪40％vs66．67％．P〈0．01）。（2）预后不同的三组患者治疗前、后6h的中心静脉全血乳酸浓度、6h乳酸清除率和24hAPACHEⅡ评分比较：好转组：MODS：死亡组分别为4．82±2．94mmol／Lvs6．08±2．29mmol／Lvs9．18±1．79mmol／L：2．19±1．40mmol／Lvs4．24±1．82mmol／Lvs9．00±2．20mmol／L；54．98％±4．13％vs31．29％±8．48％vs7．08％±12.33％：13．63±2．35vs16．78±3．00vs23．50±1．29，差异有显著统计学意义（P〈0．01）。（3）多发伤患者6h乳酸清除率与24hAPACHEⅡ评分有较高的相关性（r=-0．709，P〈0．01）。结论早期乳酸清除率是判断多发伤患者预后的一个较好指标。

The evaluation of early lactate clearance rate in outcome for multiple trauma patients

Objective To study the evaluation of early lactate clearance rate in outcome of multiple trauma patients. Methods Fifty-seven multiple trauma patients were selected. Central vein lactate were measured before and six hours after early treatment, and lactate clearance rate was calcuated, which was compared with twenty-four- hour APACHE- Ⅱ score. Results （1） When the lactate clearance rate was divided into groups by 50% and 25%, the mortality and mobidity of multiple organ dysfunction syndrome（MODS） in different lactate clearance rate group showed statistical differences （0 vs 4% vs 33.33% and 8.70% vs 40% vs 66.67%, P〈0.01）. （2） Central vein lactate before and six hours after early treatment and lactate clearance and twenty-four-hour APACHE- Ⅱ score in different outcome group were compared, and upturn vs MODS vs death was 4.82±2.94 mmol/L vs 6.08±2.29 mmol/L vs 9.18±1.79mmol/L;2.19± 1.40mmol/L vs 4.24±1.82mmol/L vs 9.00±2.20 mmol/L;54.98%±4.13% vs 31.29%±8.48% vs 7.08%±12.33%; 13.63±2.35 vs 16.78±3.00 vs 23.50±1.29, all showing statistical differences （P〈0.01）. （3） There was an obvious correlation between six-hour lactate clearance rate and twenty-four-hour APACHE Ⅱ score in multiple trauma patients （r=-0.709, P〈0.01）. Conclusion Early lactate clearance rate can be regarded as a good indicator of outcome to multiple trauma patients.