动态监测重症肺炎患者血乳酸、中心静脉血氧饱和度及D-二聚体的临床意义

摘要

目的 回顾性分析重症肺炎患者动态检测动脉血乳酸,中心静脉血氧饱和度(ScvO2)及D-二聚体的变化.方法 68例重症肺炎患者中,52例存活(存活组)及16例死亡(死亡组),分析比较两组动脉血乳酸、6h内乳酸清除率、ScvO2及D-二聚体的变化；结合急性生理学、年龄及既往疾病评估预后系统(APACHEⅡ)评分,分析其在疾病转归与预后的价值.结果 存活组血乳酸水平明显低于死亡组,其血乳酸在入院治疗12 ～24 h迅速降低到正常水平,而死亡组血乳酸呈持续高水平状态；存活组患者的ScvO2明显高于死亡组,且维持在正常水平,而死亡组ScvO2低于正常且持续下降.死亡组D-二聚体水平72 h内无明显下降,较存活组明显升高(P＜0.05).APACHE评分与血乳酸浓度呈正相关(r=0.656,P＜ 0.05).结论 重症肺炎患者动态监测血乳酸、ScvO2及D-二聚体水平在评估疗效,判断预后中具有重要意义.%Objective To analyze the clinical significance of dynamic monitoring blood lactic acid,ScvO2 and D-dimer in patients with severe pneumonia.Methods The clinical data of 68 cases with severe pneumonia were collected.According to clinical outcomes,the patients were divided into survival group (n =52) and dead group (n =16).A series of blood lactic acid,ScvO2,D-dime and APACHE Ⅱ were retrospective analyzed in order to explore whether these values have the clinical significance for prognosis of the patients.Results There were no difference in age,sex,ScvO2,the initial concentrations of blood lactic acid,D-dimer and scores of APACHE Ⅱ at admission to ICU.However,blood lactic acid levels were decreased to the normal level after treatment within 12 to 24 h in the survival group while it maintained higher level in the dead group even after treatment of 72 h (P ＜ 0.05).ScvO2 in the survival group was significantly higher than that in the dead group.Moreover,ScvO2 was maintained in normal level in the survival group while ScvO2levels were below normal and continues to decline.There was a positive correlation between blood lactic acid and APACHE scores (r =0.656,P ＜0.05).Conclusions The dynamic monitoring levels of blood lactic acid,ScvO2 and D-dimer in patients with severe pneumonia is not only can be used to evaluate the therapeutic efficiency,but also provide a prognosis for patients with severe pneumonia.