早期乳酸清除率在创伤性低血容量性休克患者预后评估中的价值

摘要

Objective To investigate the fast,simple,effective and practical indicator for evaluating the prognosis in the patients with traumatic hypovolemic shock. Methods 34 patients with traumatic hypovolemic shock in ICU of the Neijiang Mu-nicipal Second People′s Hospital from July to December 2012 were selected. The ISS ,APACHEⅡscores were determined when admitting in ICU and the arterial blood lactic acid value was monitored,re-detection was conducted at 6,12,24 h,the blood lac-tate clearance rate at 6,12,24 h was calculated. According to the outcomes of disease,the patients were divided into the survival group(28 cases) and the death group(6 cases). The blood lactic acid values at 0,6,12,24 h,lactic acid clearance rate at 6,12, 24 h,ISS score and APACHEⅡscore and their relation with prognosis were compared. Results The ISS score and APACHEⅡscore in the survival group were lower than those in the death group,the difference was statistically significant(P<0.05). The blood lactic acid level immediately admitting to ICU had no statistical difference between the two groups (P>0.05). The initial arterial blood lactic acid value in the survival group was lower than that in the death group ,but without statistical difference (P>0.05),the blood lactic acid level at 6, 12, 24 h after treatment showed the decreasing trend,while which in the death group was continuously increased,the difference was statistically significant(P<0.05). The lactic acid clearance rate at 6,12,24 h after treatment in the survival group was significantly higher than that in the death group ,the differences were statistically significant. Conclusion The 6 h lactic acid clearance rate can be used for the early evaluation of prognosis in the patients with traumatic hy-povolemic shock.%目的：探讨评估创伤性低血容量性休克患者预后快捷、简便、有效、实用的指标。方法选取2012年7～12月内江市第二人民医院重症监护病房（ICU）收治的34例创伤性低血容量性休克患者，入ICU时进行损伤严重度（ISS）评分、急性生理与慢性健康评分（APACHEⅡ评分）并监测其动脉血乳酸值，6、12、24 h后复检，计算出6、12、24 h血乳酸清除率。根据疾病转归，将患者分为存活组28例，死亡组6例。比较两组0、6、12、24 h血乳酸值，6、12、24 h血乳酸清除率，ISS评分，APACHEⅡ评分与预后的关系。结果存活组ISS评分、APACHEⅡ评分均低于死亡组，差异有统计学意义（P<0.05）。入ICU即刻，两组患者血乳酸水平比较，差异无统计学意义（P＞0.05）。存活组初始动脉血乳酸值低于死亡组，但差异无统计学意义（P＞0.05），治疗后6、12、24 h乳酸水平呈下降趋势，而死亡组持续升高，差异均有统计学意义（P＜0.05）。存活组治疗后6、12、24 h血乳酸清除率均明显高于死亡组，差异均有统计学意义（P＜0.05）。结论6 h血乳酸清除率可用于早期评估创伤性低血容量性休克患者的预后。