动脉乳酸清除率对严重脓毒症患者预后的评估

目的 研究动脉乳酸清除率对严重脓毒症患者预后的评估价值.方法 对62例重度脓毒症患者测定人院时和治疗后6 h动脉血乳酸水平,计算6 h乳酸清除率.根据24 h内最差生命体征、生化指标、年龄及是否手术计算APACHEⅡ评分.根据预后将患者分为存活组和死亡组,比较一般资料.再按照6 h乳酸清除率高低分为3组,比较病死率,并与APACHEⅡ评分作一致性分析,判断动脉乳酸清除率评价预后的价值.结果 存活组乳酸清除率明显高于死亡组;随着6 h乳酸清除率降低,病死率明显升高（P〈0.05）;在预后判断上乳酸清除率与APACHEⅡ评分有较高的一致性（P〉0.05）.结论 6 h动脉乳酸清除率是预测严重脓毒症患者预后的有效指标,早期动态监测严重脓毒症患者动脉乳酸及其清除率是判断预后的良好方法.

Arterial blood lactate clearance rate for the assessment of prognosis in patients with severe sepsis

Objective To discuss the value of arterial blood lactate clearance rate for the assessment of prognosis in patients with severe sepsis. Methods 62 patients with severe sepsis were collected detecting arterial blood lactate when admitted and after 6 h to calcuate 6 h clearance rate. APACHE II scores were calculated according to the worst vital signs within 24 hours, biochemical indicators, age and surgery situation. According to prognosis, the patients were divided into the survival group and death group to compare general information. Then patients were divided into 3 group based on arterial blood lactate clearance rate and to compare mortality. Through consistency analysis with APACHE II , it determines the value of arterial blood lactate clearance rate for the assessment of prognosis in patients with severe sepsis. Resuits In arterial blood lactate clearance rate, survival group was significantly higher than the death group. As 6 h lactate clearance rate decreased, the mortality rate was significantly increased. It had a significant difference （P 〈 0.05 ）. On the evaluation of prognosis, the lactate clearance rate and APACHE II score had a good consistency （ P 〉 0.05 ）. Conclusion 6 h arterial lactate cleararlce rate is an effective indicator to predict the prognosis of patients with severe sepsis. It is a good method to determine the prognosis of patients with severe sepsis that monitors arterial lactate and its clearance rate early and dynamically.