动脉血乳酸浓度动态变化对脓毒性休克患者预后的评估价值研究

目的探讨动脉血乳酸浓度动态变化对脓毒性休克患者预后的评估价值。方法选择脓毒性休克患者40例,采用早期目标指导治疗(EGDT),将其中死亡患者15例作为死亡组,其余25例作为存活组,比较其在入院时、入院6h和入院24h动脉血乳酸水平及乳酸清除率。结果存活组入院时、入院6h、入院24h血乳酸浓度均低于死亡组,差异有统计学意义(P<0.01)。存活组6h乳酸清除率和24h乳酸清除率均高于死亡组,差异有统计学意义(P<0.05)。结论动脉血乳酸浓度持续增高或6h乳酸清除率低的脓毒性休克患者预后差,6h乳酸清除率较24h乳酸清除率具有良好的早期预后评估作用。

Prognosis dynamic changes in arterial blood lactate in patients with septic shock

Objective To study evaluation of the dynamic changes in arterial blood lactate concentration in critical illness patients with septic shock. Methods 40 patients ultimately enrolled in the patients with septic shock received early goal-directed therapy （EGDT） ,among whom, 15 patients died and were regarded as a death group, the remaining 25 cases as the survival group, arterial blood lactate levels and lactate clearance during their admission ,6h and 24h after hospital admission were compare. Results Blood lactate concentrations in survival group on admission,and 6h and 24h after admission were lower than those in the death group,and the differences were statistically significant （P 〈 0.01 ）. Rates of blood lactate 6h after administration and lactate clearance rate 24h after administration in survival group were higher than those in death group, and the differences were statistically significant （ P 〈 0.05 ）. Conclusion Increasing arterial blood lactate concentration and lower lactate clearance rates of 6 hours show poor prognosis in patients of septic shock,lactate clearance rate in 6 hours plays an important role of good early prognosis rather than that in 24 hours.