Value of arterial blood lactate and early lactate clearance in evaluating the prognosis in patients with COPD merged with respiratory failure

摘要

Objective: To explore the value of arterial blood lactate and early lactate clearance inevaluating the prognosis in patients with COPD merged with respiratory failure. Methods:A total of 78 patients with COPD merged with respiratory failure were included in the study.The arterial blood lactate level 1 d before treatment and 6 h after treatment was detected.The early lactate clearance was evaluated. The patients were divided into the severe elevationgroup, mild elevation group, and normal control group according to the blood lactate level.APACHE Ⅱ score, 28 d death rate, and other clinical related indicators in the three groupswere compared. According to the early lactate clearance, the patients were divided intothe high lactate clearance group and low lactate clearance group. The arterial blood lactatelevel, APACHE Ⅱ score, death rate, and arterial blood gas indicators in the two groupswere compared. The multiple-factor analysis of prognosis was performed. Results: With theincreasing of blood lactate concentration before treatment, APACHE Ⅱ score, mechanicalventilation time, ventilation rate, hospitalization time, and death rate were gradually elevated,and the comparison among the three groups was not statistically significant. When comparedwith before treatment, the arterial blood lactate level, APACHE Ⅱ score, and PaCO2 in thehigh lactate clearance group were significantly reduced, but PaO2 and pH were significantlyelevated, while PaO2 in the low lactate clearance group was significantly elevated. The deathrate in the high lactate clearance group was significantly lower than that in the low lactateclearance group. The early lactate clearance was a factor in protecting the prognosis in patientswith COPD merged with respiratory failure. Conclusions: The arterial blood lactate level andearly lactate clearance can affect the prognosis in patients with COPD merged with respiratoryfailure. Dynamic monitoring of early blood lactate level can better evaluate the disease severitydegree and prognosis.