重症肺炎液体复苏患者乳酸清除率、氧合指数与预后相关性研究

摘要

Objective To study lactate clearance,oxygenation index,and prognostic correlation of patients with severe pneumonia treated with liquid recovery. Methods 56 cases of patients with severe pneumonia treated with liquid recovery were retrospectively studied. Patients re-ceived arterial blood lactic acid concentration and early ScvO2 testing in hospital and 6h after hospitalization,to calculate the 6 h lactate clearance. At the same time,patients received APACHEⅡ evaluation and were divided into three groups based on the score:10 ~ 19(group A);20 ~ 29 (group B);30 and above(group C). The early lactate clearance and ScvO2 in different groups were compared,with their relations with prognosis analyzed. Results The early 6 h lactate clearance rate and ScvO2 of group B were significantly lower than group A. The difference was significant ( P < 0. 05). The early 6 h lactate clearance rate and ScvO2 of group C were significantly lower than group B. The difference was significant( P< 0. 05). The mortality of group B was significantly higher than group A,while group C was significantly higher than group B. The differences were significant( P < 0. 05). The APACHEH Ⅱ score of the death group was significantly higher than the survival group,while the early arterial blood lactate clearance and ScvO2 level were significantly lower than the survival group,with significant difference( P < 0. 05). APACHEH Ⅱscore was in negative correlation with early lactate clearance( r = 0. 659,P < 0. 05),and significant negative correlation with early ScvO2 level ( r = 0. 577,P < 0. 05). Conclusion Early arterial blood lactate clearance and ScvO2 level can objectively reflect the severity of the disease of patients with severe pneumonia liquid recovery,and can be two important reference indexes for the prediction of patient outcome.%目的：探讨重症肺炎液体复苏患者乳酸清除率、氧合指数与预后相关性。方法对56例重症肺炎液体复苏患者进行回顾性研究，患者在入院即刻与6 h 分别进行动脉血乳酸浓度以及氧合指数，计算6 h 乳酸清除率。同时对患者进行急性生理与慢性健康（APACHE Ⅱ）评分，根据评分将患者分为3组：10~19分（A 组）；20~29分（B 组）：≥30分（C 组）。比较不同组别患者早期乳酸清除率与氧合指数的差异，并分析其与预后的关系。结果 B 组早期6 h 乳酸清除率、氧合指数均明显低于 A 组，差异有显著性（ P ＜0.05）；C 组早期6 h 乳酸清除率、氧合指数均明显低于 B组，差异有显著性（ P ＜0.05）；B 组患者病死率明显高于 A 组，而 C 组患者病死率明显高于 B 组，差异均有显著性（ P＜0.05）；死亡组 APACHEH Ⅱ评分明显高于存活组，而早期动脉血乳酸清除率与氧合指数明显低于存活组，差异有显著性（ P ＜0.05）；APACHEH Ⅱ评分与早期乳酸清除率呈现明显的负相关（ r =0.659，P ＜0.05），而与早期氧合指数呈现明显的负相关（ r =0.763，P ＜0.05）。结论早期动脉血乳酸清除率以及氧合指数能够客观反映重症肺炎液体复苏患者病情的严重程度，并能够作为预测患者转归的两个重要参考指标。