早期乳酸清除率对老年呼吸衰竭患者预后的评估

目的 探讨早期血乳酸清除率对老年呼吸衰竭患者的临床意义. 方法 对68例老年呼吸衰竭患者进行前瞻性研究,根据患者病情转归分为存活组49例和死亡组19例.测定入科时与治疗6h后的动脉血乳酸水平、动脉血气分析,急性生理与慢性健康状况(APACHEⅡ)评分及早期(6 h)乳酸清除率.同时,以早期乳酸清除率10％为临界值分为高、低乳酸清除率2组,比较早期乳酸清除率与预后的关系. 结果 治疗前存活组与死亡组比较,动脉血乳酸pH值、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、APACHEⅡ评分、氧合指数等均无统计学差异.治疗6h后存活组与死亡组比较,早期乳酸清除率、动脉血乳酸水平、PaCO2、PaO2、氧合指数等差异均有显著性(P＜0.05),高乳酸清除率组病死率为4.7％,显著低于低乳酸清除率组68％,2组比较差异有统计学意义(P＜0.01). 结论 早期乳酸清除率可作为评估老年呼吸衰竭患者初始治疗效果及预后的指标,并指导下一步治疗.

Effect of early lactate clearance rate on evaluation of prognosis in elderly patients with respiratory failure

Objective To evaluate the correlation between the prognosis and the early lactate clearance rate in elderly respiratory failure patients.Methods The data of 68 elderly patients with respiratory failure were analyzed prospectively.The patients were divided into survival group(n=49) and death group(n=19).Arterial blood lactate,arterial gas analysis,APACHE Ⅱ score and the 6 h clearance rate were analyzed before and 6 h after treatment in two groups.The high lactate clearance rate group presented with a lactate clearance rate≥10%,and low lactate clearance rate group presented with a lactate clearance rate <10%.The correlation between 6 h lactate clearance rate and prognosis of two groups was analyzed.Results There were no statistical differences in arterial blood lactate,pH value,PaCO2,PaO2,APACHEⅡ and oxygenation index before treatment between the survival group and the death group.6 h after treatment there were significant differences in arterial blood lactate,lactate clearance rate,PaCO2,PaO2 and oxygenation index between two groups(P<0.05).Mortality in high lactate clearance rate group(4.7%) was significantly lower than that in low lactate clearance rate group(68%)(P<0.01).Conclusions The early lactate clearance rate might predict the prognosis of patient with respiratory failure in early phase,and guide the further treatment.