血乳酸水平对重症肺炎ARDS并发感染性休克病人预后的预测价值

目的探究入院时血乳酸水平对重症肺炎急性呼吸窘迫综合征（ARDS）并发感染性休克病人预后的预测价值，为临床预测病人死亡率提供依据。方法选取102例重症肺炎ARDS并发感染性休克病人，收集病人入院时临床生化资料。根据入院后28d存活情况将病人分为死亡组和存活组，观察血乳酸水平与死亡率相关性，并分析其对28d死亡率的预测价值。结果共40例死亡（39.2%），死亡组SOFA评分、APACHEⅡ评分高于存活组（P < 0.05），住院时间长于存活组（P < 0.05）。死亡组动脉血乳酸水平明显高于存活组（P < 0.01）。2组pH值、剩余碱、碳酸氢盐、二氧化碳分压及氧分压差异均无统计学意义（P>0.05）。ROC分析显示，乳酸预测28d死亡的曲线下面积为0.77，灵敏度为64.2%，特异度为79.9%。多因素分析显示，乳酸、SOFA评分是病人28 d死亡的独立危险因素（P < 0.01和P < 0.05）。结论动脉血乳酸水平升高的重症肺炎ARDS并发感染性休克病人预后较差，其水平可用于预测病人28 d死亡率。

Prognostic value of blood lactate level on severe pneumonia patients with ARDS complicated with septic shock

ObjectiveTo investigate the predictive value of blood lactate level on the prognosis of severe pneumonitis patients with acute respiratory distress syndrome(ARDS) complicated with septic shock at admission, and provide evidence for the clinical prediction of patient's mortality.MethodsA total of 102 severe pneumonia patients with ARDS complicated with septic shock were selected, and the clinical and biochemical data of patients were collected.The patients were divided into the death group and survival group according to the survival condition after 28 days of admission.The correlation between blood lactate level and mortality was observed, and the predictive value of 28-day mortality was analyzed.ResultsThere were 40 deaths(39.2%).The SOFA score and APACHE Ⅱ score in death group were higher than those in survival group(P < 0.05), the hospital stay in death group was longer than that in survival group(P < 0.01), and the blood lactate level in death group was higher than that in survival group(P < 0.01).The differences of the levels of pH, BE, bicarbonate, PCO₂ and PO₂ between two groups were not statistically different(P>0.05).The results of ROC analysis showed that the area under the curve of lactate predicting 28-day mortality was 0.77, and the specificity and sensitivity were 64.2% and 79.9%, respectively.The results of multivariate analysis showed that the lactate[OR(95% CI):3.458(1.441-10.027)] and SOFA score[OR(95% CI):1.524(1.276-5.034)] were the independent risk factors of 28-day mortality of patients(P < 0.01 and P < 0.05).ConclusionsThe severe pneumonia patients with ARDS complicated with septic shock with increasing arterial blood lactate level have a poor prognosis, and the arterial blood lactate level can be used to predict 28-day mortality.