动脉血乳酸及乳酸清除率对颅脑外伤患者的预后评估价值

摘要

Objective After acute craniocerebral trauma , to a certain extent , arterial blood lactate and lactate clearance rate reflect the illness severity .We aimed to investigate the prognosis value of arterial blood lactate and lactate clearance rate in patients with craniocerebral trauma . Methods 94 cases with craniocerebral trauma treated in the Department of Emergency of Nanjing General Hospital of Nanjing Military Regionfrom February 2015 to November 2015 were retrospecively analysed .GCS ( Glasgow Coma Scale ) score, arterial blood lactate , blood pressureand heart rate were measured once patients admitted to hospital and 6 hours later ,arterial blood lactate was measured again to calculated the arterial blood lac-tate clearance rate .Based on the GCS score , we divided the patients into mild group (13-15), medium group (9-12) and severe group (3-8).We also divided the patients into death group and survival group according toprognosis .We compared arterial blood lactate and lactate clearance rate betweeeneach group respectively . Results There were significant differences in arterial blood lactate (F=19.99,P<0.01) and 6h lactate clearance rate(F=6.21,P<0.01)be-tween lighter group , medium group and severe group .The initial arterial blood lactate of death group was significantly higher than sur-vival group[(4.20 ±1.36)mmol/L vs (1.58 ±0.93)mmol/L], the difference was statistically significant (t=-9.78,P<0.01). The 6 h lactate clearance rate of death group was significantly lower than survival group [(31.73 ±12.84)%vs (46.25 ±12.01)%], the difference was statistically significant (t=4.55,P<0.01). Conclusion Arterial blood lactate and 6 h lactate clearance rate can evaluate the severity and prognosisof illnessin patients with craniocerebral traumaand have important application value in clinical work .%目的：急性颅脑外伤后，患者动脉血乳酸及乳酸清除率在一定程度上反应了病情严重程度。文中旨在探讨动脉血乳酸及乳酸清除率在评估颅脑外伤患者预后的价值。方法回顾性分析南京军区南京总医院急诊科2015年2月至2015年11月收治的颅脑外伤患者94例基本资料。在患者入院时立即进行GCS评分，动脉血乳酸、血压、心率的测定，在入院6 h后再次测定动脉血乳酸浓度，计算其动脉血乳酸清除率。将所有患者分别按格拉斯哥昏迷评分分值分为轻度组（13～15分）、中度组（9～12分）和重度组（3～8分），并根据预后分为死亡组和存活组，分别比较各组的动脉血乳酸值及乳酸清除率。结果轻、中、重度3组动脉血乳酸浓度间差异有统计学意义（F＝19．99，P＜0．01），且6 h乳酸清除率组间差异亦有统计学意义（F＝6．21，P＜0．01）。死亡组的初始血乳酸浓度明显高于存活组[（4．20±1．36）mmol／L vs （1．58±0．93）mmol／L]，差异有统计学意义（t＝－9．78，P＜0．01）；死亡组的6 h乳酸清除率明显低于存活组[（31．73±12．84）％ vs （46．25±12．01）％]，差异有统计学意义（t＝4．55，P＜0．01）。结论在颅脑外伤的患者中，动脉血乳酸及6 h乳酸清除率可较好地评估患者的病情程度及预后，在临床中具有重要应用价值。