早期乳酸清除率对呼吸衰竭患者预后评估的作用

目的探讨早期乳酸清除率对呼吸衰竭患者预后评估的作用。方法收集呼厥内科重症监护室（RICU）内入院时血乳酸升高的呼吸衰竭患者117例，检测治疗前、治疗后12h、24h、48h及72h动脉血乳酸值及动脉血气，计算12h乳酸清除率，并作入院时及入院后12h急性生理学及慢性健康状况评价II（APACHEII）评分。比较血乳酸恢复正常时间与患者预后的关系；比较不同预后患者的临床特征；以血乳酸清除率10％为界分为高乳酸清除率组（〉10％）和低乳酸清除率组（〈10％），比较两组患者的预后及相关指标的差异。结果血乳酸值24h内恢复正常组与血乳酸值72h内未恢复正常组比较，预后有明显差异（P〈0．001）；存活组12h乳酸清除率（43．6％±26．8％）明显高于死亡组（12．3％±39．1％，P〈0．01）；高乳酸清除率组病死率（25．8％）明显低于低乳酸清除率组（71．4％，P〈0．01）。结论早期乳酸清除率可作为判断呼吸衰竭患者预后的一个指标。

Prognostic Value of Early Lactate Clearance Rate in Patients with Respiratory Failure

Objective To explore the prognostic value of early lactate clearance rate in patients with respiratory failure. Methods 117 patients with respiratory failure and elevated blood lactate, admitted into respiratory intensive care unit（RICU） between January 2010 and December 2011, were retrospectively analyzed. Arterial lactate and arterial blood gas were measured before and 12h,24h,48h, and 72h after treatment. Then 12h lactate clearance rate was calculated. The acute physiology and chronic health evaluation 11 （ APACHE Ⅱ ） score was evaluated before and after 12h treatment. The mortality were compared between subgroups with different lactate normalization time （ 〈 24 h, 24 - 48 h,48 - 72 h, and 〉 72h, respectively）. The clinical data was compared between subgroups with different prognosis （ survival or non-survival） and between subgroups with different lactate clearance rate（ 〉110% as high lactate clearance rate, 〈 10% as low lactate clearance rate）. Results The mortality of the patients with lactate normalization time in less 24 hours was significantly lower than that of the patients with lactate normalization time more than 72 hours （5.3% vs. 89. 2% ,P 〈 0. 001 ）. The 12 hour lactate clearance rate of the survival group was significantly higher than that of the non-survival group [ （43.6 ± 26. 8） % vs. （ 12. 3 ± 39. 1 ） %, P 〈 0. 01 ]. The mortality of the patients with high lactate clearance rate was significantly lower than that of the patients with low lactate clearance rate（25. 8% vs. 71, 4% ,P 〈 0. 01 ）. Conclusion Early lactate clearance rate can be used as a marker for prognosis of patients with respiratory failure.