CAJ | 학술논문

目的探讨乳酸动态监测指标与重症监护病房(ICU)危重患者预后的相关关系,并对这种关系进行量化评价.方法收集101例乳酸升高的危重患者,分为死亡组(50例)和存活组(51例),比较两组的乳酸监测指标(乳酸水平、乳酸升高时间、乳酸清除率)、急性生理学与慢性健康状况评分系统Ⅰ(APACHE Ⅰ)评分及其他反映器官功能的指标,使用logistic回归分析找出与预后显著相关的指标.以相应的乳酸指标进行量化分组,分别比较各组休克和多器官功能障碍综合征(MODS)发生率、APACHE Ⅰ评分和病死率.结果死亡组入ICU乳酸值、乳酸峰值、APACHE Ⅰ评分高于存活组,12 h和24 h乳酸清除率、pH值低于存活组(P<0.05或P<0.01).乳酸峰值、12 h乳酸清除率、APACHE Ⅰ评分和pH值与患者的预后明显相关,相对比值比(OR)分别为1.466、0.922、1.208、0.032.乳酸峰值≥10 mmol/L、12 h乳酸清除率≤10%的患者病死率明显升高,分别为77.8%和70.6%(P<0.05和P<0.01),乳酸升高时间>24 h时病死率虽升高,但无统计学意义.结论乳酸峰值、12 h乳酸清除率、APACHE Ⅰ评分和pH值是评价患者预后的良好指标.乳酸峰值≥10 mmol/L、12 h乳酸清除率≤10%时应警惕患者较差的预后,而乳酸升高时间评价预后的价值有限.
목적 탐토유산동태감측지표여중증감호병방(ICU)위중환자예후적상관관계,병대저충관계진행양화평개.방법 수집101례유산승고적위중환자,분위사망조(50례)화존활조(51례),비교량조적유산감측지표(유산수평、유산승고시간、유산청제솔)、급성생이학여만성건강상황평분계통Ⅰ(APACHE Ⅰ)평분급기타반영기관공능적지표,사용logistic회귀분석조출여예후현저상관적지표.이상응적유산지표진행양화분조,분별비교각조휴극화다기관공능장애종합정(MODS)발생솔、APACHE Ⅰ평분화병사솔.결과 사망조입ICU유산치、유산봉치、APACHE Ⅰ평분고우존활조,12 h화24 h유산청제솔、pH치저우존활조(P<0.05혹P<0.01).유산봉치、12 h유산청제솔、APACHE Ⅰ평분화pH치여환자적예후명현상관,상대비치비(OR)분별위1.466、0.922、1.208、0.032.유산봉치≥10 mmol/L、12 h유산청제솔≤10%적환자병사솔명현승고,분별위77.8%화70.6%(P<0.05화P<0.01),유산승고시간>24 h시병사솔수승고,단무통계학의의.결론 유산봉치、12 h유산청제솔、APACHE Ⅰ평분화pH치시평개환자예후적량호지표.유산봉치≥10 mmol/L、12 h유산청제솔≤10%시응경척환자교차적예후,이유산승고시간평개예후적개치유한.
Objective To study and quantify the relationship between dynamic lactic acid monitoring indexes and prognosis of critically ill patients in intensive care unit (ICU). Methods One hundred and one critically ill patients with elavated blood lactic acid level were included in this study and divided into death group (n= 50) and survival group (n = 51). Differences in their lactic acid indexes (including: lactic acid level, duration of lacticemia, lactic clearance), acute physiology and chronic health evaluation Ⅰ (APACHE Ⅰ ) score, and other clinical indicators which reflected organ/system status were compared, and prognostic significant lacticemia indexes were formulated by multi-variable logistic analysis. Subsequently, patients were grouped by significant lactic indexes separately and compared with incidence of shock/multiple organ dysfunction syndrome (MODS), APACHE Ⅰ score and mortality. Results Differences in lactic acid level, peak lactic acid level, 12-hour and 24-hour lactic acid clearance between death group and survival group showed statistically significant difference (P<0. 05 or P<0. 01). Peak lactic acid level, 12-hour lactic clearance, APACHE Ⅰ score and blood pH had significant correlation with prognosis, odds ratios (OR) were 1. 466, 0. 922, 1. 208, 0. 032, respectively. Patients with peak lactic acid value≥10 mmol/L or 12-hour lactic clearance≤10% had significantly higher mortality: 77. 8% and 70. 6%, respectively (P<0. 05 and P< 0.01). Although patients with lacticemia > 24 hours had higher mortality, there was no statistically significant difference. Conclusion Peak lactic acid level, 12-hour lactic clearance, APACHE Ⅰ score and blood pH are good indicators to evaluate patients' prognosis. Peak lactic acid value≥10 mmol/L or 12-hour lactic clearance≤10% is an alert of extremely bad prognosis. Prognosis value of duration of lacticemia is limited.