早期乳酸清除率与血糖水平对脑复苏结局的影响

摘要

目的：探讨乳酸清除率和血糖水平对脑复苏临床预后的评估效能。方法回顾性分析2011年1月至2015年9月89例脑复苏患者的临床资料和实验室检查结果。根据89例患者7d预后情况分良好组及不良组，并对患者各项数据指标进行统计学分析，绘制相关指标的受试者工作特征曲线（ROC曲线）。结果经综合治疗后预后良好组22例，预后不良组67例。预后良好组的6h、12h、24h乳酸清除率均高于预后不良组，而预后良好组的入院即时血糖、2h、4h、6h血糖均低于预后不良组，两组比较差异有统计学意义（P<0.05）；多因素Logistic回归分析：6h乳酸清除率（OR=0.656，95%CI 0.870~0.989，P=0.008）、6h血糖（OR=2.788，95%CI 0.833~0.977，P=0.015）为脑复苏预后的独立影响因素。通过ROC曲线分析得到两者的预测效能：6h乳酸清除率（AUC=0.929、最佳截断值为24.55%、敏感度为86.4%、特异度为83.6%），6h血糖水平（AUC=0.905、最佳截断值为12.15mmol/L、敏感度为0.821、特异度为0.864）。结论脑复苏预后良好组早期乳酸清除率高，血糖水平低于预后不良组，两者可作为有效的预测临床转归的生物学指标。%Objective To investigate the assess efficacy of blood lactate clearance rate and blood glucose levels on the clinical outcome of cerebral resuscitation. Methods Retrospective analyzed the clinical data and laboratory indexes of patients with cerebral resuscitation in Ningbo Zhenhai Longsai hospital and Affiliated Hospital of Xiangnan Academy during January 2011 to September 2015.According to the prognosis of 7 days, 89 cases were divided into good prognosis group and poor prognosis group,and statistical analyzed the data and indexes of patients,Receiver operating characteristic(ROC)curves were drawn for these related indexes. Results After comprehensive treatments of the ICU hospitalization,total of 22 cases for good prognosis group,67 cases for poor prognosis group.Comparative analysis showed that 6h、12h、24h lactate clearance rates of good prognosis group were higher than poor prognosis group,but the immediate admission blood glucose level and 2h、4h、6h blood glucose levels were lower than the poor prognosis group,the difference of 2 groups was statistically significant(P<0.05);Then univariate analysis and multivariate Logistic regression analysis revealed 6h lactate clearance rate(OR=0.656,95%CI 0.870-0.989,P=0.008)、6h blood glucose level(OR=2.788, 95%CI 0.833-0.977,P=0.015)were independent factors to predict the prognosis of cerebral resuscitation.ROC curve analysis showed both predictive efficacy:the area under the curve of 6h lactate clearance rate was 0.929 with the optimal cutoff value of 24.55%、sensitivity of 86.4%specific degree of 83.6%;the area under the curve of 6h blood glucose level was 0.905 with the optimal cutoff value of 12.15mmol/l sensitivity of 82.1%specific degree of 86.4%. Conclusion The early lactate clearance rate of good prognosis group was higher than poor prognosis group,while blood glucose level was lower than poor group,both can be used as effective biological indicators to predict clinical outcome of cerebral resuscitation.