动脉血乳酸及早期乳酸清除率对 COPD 合并呼吸衰竭患者预后的评估价值

摘要

目的：：探讨动脉血乳酸及早期乳酸清除率对 COPD 合并呼吸衰竭患者预后的评估价值.方法：选取 COPD 并呼吸衰竭患者78例,检测治疗前1 d 及治疗后6 h 动脉血乳酸水平,计算早期乳酸清除率；根据入院血乳酸水平将患者分为重度升高组、轻度升高组和正常对照组,比较3组 APACHE Ⅱ评分、28 d 死亡率等临床相关指标.根据早期乳酸清除率,将患者分为高乳酸清除率组和低乳酸清除率组,比较2组治疗前后动脉血乳酸水平、APACHE Ⅱ评分、死亡率及动脉血气指标；对 COPD 并呼吸衰竭进行预后多因素分析.结果：随着治疗前患者血乳酸浓度的升高,其 APACHEⅡ评分、机械通气时间、通气率及住院时间、死亡率均呈升高趋势,且3组间差异有统计学意义(P ＜0．05)；与治疗前比较,高乳酸清除率组的动脉血乳酸水平、APACHEⅡ评分及 PaCO 2均有所下降,PaO2及 pH 升高(P ＜0．05),低乳酸清除率组仅 PaO 2较治疗前升高,高乳酸清除率组死亡率明显低于低乳酸清除率组(P ＜0．05)；早期乳酸清除率是 COPD 合并呼吸衰竭患者预后保护因素(P ＜0．05).结论：COPD 合并呼吸衰竭患者的动脉血乳酸水平与早期乳酸清除率均影响患者预后,动态监测早期血乳酸水平的变化,可更好地评估病情严重程度和预后.%[ABSTRACT]Objective:To explore the value of arterial blood lactate and early lactate clearance in evaluating the prognosis in patients with COPD merged with respiratory failure.Methods:A total of 78 patients with COPD merged with respiratory failure were included in the study.The arterial blood lactate level 1d before treatment and 6 h after treatment was detected.The early lactate clearance was evaluated.The patients were divided into the severe elevation group,mild elevation group,and nor-mal control group according to the blood lactate level.APACHE Ⅱ score,28 d death rate,and other clinical related indicators in the three groups were compared.According to the early lactate clearance,the patients were divided into the high lactate clearance group and low lactate clearance group.The arterial blood lactate level,APACHE Ⅱ score,death rate,and arterial blood gas indicators in the two groups were compared.The multiple-factor analysis of prognosis was performed.Results:With the increasing of blood lactate concentration before treatment,APACHE Ⅱ score,mechanical ventilation time,ventilation rate,hospitalization time,and death rate were gradually elevated,and the comparison among the three groups was statistically significant (P <0.05).When compared with that before treatment,the arterial blood lactate level,APACHE Ⅱ score,and PaCO 2 in the high lactate clearance group were significantly reduced,but PaO 2 and pH were significantly elevated (P <0.05), while PaO 2 in the low lactate clearance group was significantly elevated (P <0.05).The death rate in the high lactate clearance group was significantly lower than that in the low lactate clearance group (P <0.05).The early lactate clearance was a factor in protecting the prognosis in patients with COPD merged with respiratory failure (P <0.05).Conclusions:The arterial blood lac-tate level and early lactate clearance can affect the prognosis in patients with COPD merged with respiratory failure.Dynamic monitoring of early blood lactate level can better evaluate the disease severity degree and prognosis.