血乳酸及乳酸清除率对感染性休克预后的预测价值

摘要

Objective To Investigate the predictive value of blood lactate and lactate clearance in prognosis evaluation in septic shock. Methods 61 patients with septic shock in intensive care unit (ICU) were studied prospectively. Level of blood lactate of 0 h, 6 h, 12 h, 24 h and 72 h were measure respectively. Partial pressure of oxygen were recorded, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) were proceeded. Relationship between level of blood lactate,lactate clearance rate, the APACHE Ⅱ score and the 28-day mortality were analyzed. Results The 28-day mortality was 67.2%.Level of blood lactate in death group at 0 h, 6 h, 12 h,24 h and 72 h were higher than survival group.There was ssignificant correlation between lactate and APACHE Ⅱ score (P 〈 0.05), and no correlation with partial pressure of oxygen. 46 patients with blood lactate 〉 2.5 mmol/L. As the 12 h blood lactate clearance rate increasing, the mortality declined (P 〈 0.05). The lactate clearance rate at 6 h, 12 h and 24 h in survival group were significantly higher than death group (P 〈 0.01, P 〈 0.01, P 〈 0.05 respectively). The dosage of vasoactive agent in patients whose lactate clearance rate at 6 h ≥20.0% was lower than those 〈 20.0%(P〉 0.05). Multivariate logistic regression analysis showed that the blood lactate at 24 h, the lactate clearance rate at 6 h and 12 h were independent predictive factors of prognosis evaluation. Conclusions Dynamic observation of lactate concentration provide the predictive value of prognosis for patients with septic shock.%目的:探讨血乳酸及乳酸清除率对感染性休克预后的预测价值.方法:对收住我院ICU的感染性休克患者进行前瞻性临床观察研究,测定入院时(0 h)及入院后6、12、24和72 h血乳酸水平,同时记录血氧分压,并进行APACHE Ⅱ评分.分析血乳酸水平、乳酸清除率、APACHE Ⅱ评分和28 d病死率的关系.结果:共61例感染性休克患者纳入本研究.28 d病死率为67.2%.死亡组患者0、6、12、24和72 h血乳酸水平均显著高于存活组.所有患者入院时乳酸与APACHE Ⅱ评分显著相关(P<0.05),与血氧分压无相关性(P>0.05).46例患者入院时血乳酸>2.5mmol/L,随着12 h血乳酸清除率增加,患者的病死率降低(P<0.05),存活组6、12、24 h乳酸清除率明显高于死亡组(P<0.01,P<0.01,P<0.05).6 h乳酸清除率≥20.0%者,其病死率较<20.0%的患者降低,但差异无统计学意义(P>0.05).多元logistic回归分析显示24 h血乳酸值、6 h乳酸清除率及12 h乳酸清除率均为独立预后评估指标之一.结论:动态监测血乳酸对感染性休克患者具有重要意义,持续高乳酸血症提示预后不良,24 h血乳酸值、6 h乳酸清除率及12 h乳酸清除率可作为预后评价的指标之一.