动态监测乳酸对多发伤患者预后评价的意义

摘要

目的 探讨动态监测乳酸水平在多发伤患者预后评估中的价值.方法 对多发伤患者入院时及入院后6h、24h作动脉乳酸水平测定,并作急性生理学和慢性健康评分(APACHEⅡ评分).乳酸清除率≥30%定为高清除率,10%～29%为中清除率,<10%为低清除率.根据多发伤患者预后不同分为好转组和终点事件组(多器官功能障碍或28d内死亡),比较两组患者与乳酸清除率关系.结果 终点事件组17例(入院28d内死亡6例,出现多脏器功能障碍11例),24h内乳酸、APACHEⅡ评分终点事件组均高于好转组,入院时及6h、24h时乳酸清除率终点事件组均低于好转组.随着乳酸清除率的降低,终点事件发生率逐渐升高.结论 动态监测乳酸水平可以早期评估多发伤患者预后转归.%Objective To observe the value of monitoring the change of blood lactate concentration in outcome for multiple trauma patients. Methods We selected 51 cases with multiple trauma, detected the early blood lactic acid ( hospital admission, 6h, 24h ) , recorded APACHE Ⅱ scores, and paid attention to the prognosis.All patients were divided into two groups, one was improved group, the other was endpoint events group (MODS or death in 28 days) .According to 6 hours blood lactic acid clearance, patients were divided into three groups, high blood lactic acid clearance ( ≥30% ) , middle blood lactic acid clearance ( ≥10% and <30% ) , low blood lactic acid clearance (<10% ) . Results There were 17 cases for endpoint events on admission in 28 days, including 6 cases for death, and 11 cases for MODS. For blood lactic acid and APACHE 11 scores within 24 hours, endpoint events group was higher than improved group. all showing statistical differences ( P<0.05 ) . For the blood lactic acid clearance of 6 hours and 24hours on admission, endpoint events group was lower than improved group, all showing statistical differences (P<0.05 ) .With the reduction in lactate clearance rate of 6 hours on admission, the incidence of endpoint events increased gradually. Conclusion Monitoring the change of blood lactate concentration can help early distinguishing the prognosis of multiple trauma patients.