血乳酸水平监测对老年危重患者预后的意义

目的探讨老年危重患者血乳酸水平与预后的相关关系,为临床治疗提供指导。方法回顾性分析卫生部北京医院2008年2月～2012年2月重症监护病房收治的老年危重症患者临床资料,根据患者预后分为存活组和死亡组,检测患者入住ICU时、入院后6 h静脉血乳酸水平,计算6 h乳酸清除率,并行急性生理学及慢性健康状况评分（APACHEⅡ）,分析乳酸清除率与老年危重症患者预后的关系。结果入院治疗期间患者死亡率为30.0%（30/100）;存活组血乳酸平均值为（4.12±3.20）mmol/L,阳性率为52.86%,死亡组血乳酸平均值为（8.86±5.60）mmol/L,阳性率为96.67%;两组比较差异有统计学意义（P〈0.05）。血乳酸平均值≥10.0 mmol/L时患者死亡率最高为95.45%,血乳酸平均值≤2.40 mmol/L时患者死亡率最低为3.84%。存活组6 h乳酸清除率（38.73±2.22）%]明显高于死亡组（16.21±2.30）%];存活组APACHEⅡ评分为（17.19±6.30）分,明显低于死亡组的（25.84±5.26）分,差异均有统计学意义（P〈0.05）。高乳酸血症患者APACHEⅡ评分和院内死亡率明显低于乳酸酸中毒患者,差异有统计学意义（P〈0.05）;高乳酸血症患者乳酸清除率明显高于乳酸酸中毒者,且差异有统计学意义（P〈0.01）。低清除率组死亡人数明显高于高清除率组,且差异有统计学意义（P〈0.05）。血乳酸水平与A-PACHEⅡ评分呈正相关（r=0.572,P〈0.05）;血乳酸水平与院内死亡率呈正相关（r=0.506,P〈0.05）。结论血乳酸是评价老年危重患者预后的良好指标,血乳酸值≥5.5 mmol/L应警惕患者有较差的预后,老年危重患者血乳酸水平与APACHEⅡ评分呈正相关,可作为评价危重病情的重要指标。

Significance of blood lactate level monitoring for prognosis of elderly critical patients

Objective To investigate the relationship of blood lactate（LAC） level and prognosis of elderly critical patients,to provide guidance for clinical treatment.Methods Clinical data of elderly critical patients in ICU of Beijing Hospital of Ministry of Health from February 2008 to February 2012 were analyzed retrospectively.All patients were divided into the survival group and the death group,according to the prognosis.Venous blood LAC level in ICU admission,6 h after admission were detected,then the 6 h LAC clearance rate was calculated.All patients were given parallel acute physiology and chronic health evaluation（APACHE Ⅱ）,the relationship between LAC clearance rate and prognosis of elderly critical patients were analyzed.Results During the hospitalization,mortality of patients was 30.0%（30/100）.The average LAC level of the survival group was（4.12 ±3.20） mmol/L,with the positive rate of 52.86%; which of the death group was（8.86 ±5.60） mmol/L,with the positive rate of 96.67%,the difference between the two groups was significant（P 0.05）.When LAC level ≥ 10.0 mmol/L,the mortality rate of patients was the highest（95.45%）,when LAC level ≤ 2.40 mmol/L,the mortality rate was the lowest（3.84%）.6 h LAC clearance rate of the survival group （38.73±2.22）%] was significantly higher than that of the death group （16.21 ±2.30）%],the APACHE Ⅱ score of the survival group （17.19±6.30） points] was significantly lower than that of the death group （25.84 ± 5.26） points],the differences were statistically significant（P 0.05）.APACHE Ⅱ score and hospital mortality in patients with hyperlactacidemia were significantly lower than those with lactic acidosis,the differences were statistically significant（P 0.05）,the LAC clearance rate in patients with hyperlactacidemia was higher than those with lactic acidosis（P 0.01）.The mortality of patients in low clearance rate group was significantly higher than that in high clearance rate group,and the difference was significant（P 0.05）.LAC level was positively correlated with APACHE Ⅱ score（r = 0.572,P 0.05） and hospital mortality（r = 0.506,P 0.05）.Conclusion LAC is a good indicator for evaluation of prognosis of elderly critical patients,and patients with LAC level ≥ 5.5 mmol/L should be alert to a worse prognosis. LAC of elderly critical patients is positively correlated with APACHE Ⅱ score,which can be used as an important indicator for evaluation of critical illness.