CAJ | 학술논문

目的探讨动脉血乳酸和早期乳酸清除率对老年脓毒症患者的临床意义. 方法对急诊科收治的82例老年脓毒症患者,平均年龄(78.1±8.1)岁,分别于入院、入院后6h测定动脉血乳酸,计算早期乳酸清除率,记录患者入院时的心率、血压,并在第一个24 h内进行急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分.患者入院后28 d为研究终点,将患者分为存活组(59例)和死亡组(23例),比较两组患者初始动脉血乳酸、早期乳酸清除率及APACHEⅡ评分;以入院后6h乳酸清除率分为高乳酸清除率组(乳酸清除率≥10％,59例)和低乳酸清除率组(乳酸清除率＜10％,23例),比较两组患者初始动脉血乳酸、APACHEⅡ评分及病死率；采用受试者工作特征(ROC)曲线分析动脉血乳酸、APACHEⅡ评分及早期乳酸清除率预测老年脓毒症患者预后的价值. 结果存活组和死亡组初始动脉血乳酸分别为(2.4±1.7)mmol/L和(3.9±3.2)mmol/L,差异有统计学意义(P＜0.01)；存活组和死亡组的早期乳酸清除率+ 300％分别为(339.0±28.0)％和(300.0±81.0)％,差异有统计学意义(P＜0.01)；高乳酸清除率组和低乳酸清除率组28 d病死率分别为18.6％(11/59)和52.2％(12/23),高乳酸清除率组低于低乳酸清除率组(P＜0.01)；早期乳酸清除率预测老年脓毒症患者28 d病死率最佳临界点为24.0％,敏感性72.9％,特异性65.2％,其预测价值高于APACHEⅡ评分. 结论动脉血乳酸和早期乳酸清除率可作为判断老年脓毒症患者预后的指标.
목적 탐토동맥혈유산화조기유산청제솔대노년농독증환자적림상의의. 방법 대급진과수치적82례노년농독증환자,평균년령(78.1±8.1)세,분별우입원、입원후6h측정동맥혈유산,계산조기유산청제솔,기록환자입원시적심솔、혈압,병재제일개24 h내진행급성생이학화만성건강상황평개Ⅱ(APACHEⅡ)평분.환자입원후28 d위연구종점,장환자분위존활조(59례)화사망조(23례),비교량조환자초시동맥혈유산、조기유산청제솔급APACHEⅡ평분;이입원후6h유산청제솔분위고유산청제솔조(유산청제솔≥10％,59례)화저유산청제솔조(유산청제솔＜10％,23례),비교량조환자초시동맥혈유산、APACHEⅡ평분급병사솔；채용수시자공작특정(ROC)곡선분석동맥혈유산、APACHEⅡ평분급조기유산청제솔예측노년농독증환자예후적개치. 결과 존활조화사망조초시동맥혈유산분별위(2.4±1.7)mmol/L화(3.9±3.2)mmol/L,차이유통계학의의(P＜0.01)；존활조화사망조적조기유산청제솔+ 300％분별위(339.0±28.0)％화(300.0±81.0)％,차이유통계학의의(P＜0.01)；고유산청제솔조화저유산청제솔조28 d병사솔분별위18.6％(11/59)화52.2％(12/23),고유산청제솔조저우저유산청제솔조(P＜0.01)；조기유산청제솔예측노년농독증환자28 d병사솔최가림계점위24.0％,민감성72.9％,특이성65.2％,기예측개치고우APACHEⅡ평분. 결론 동맥혈유산화조기유산청제솔가작위판단노년농독증환자예후적지표.
Objective To explore the clinical prognostic significance of arterial blood lactate level and early lactate clearance rate in elderly septic patients. Methods Totally 82 elderly septic patients who were admitted into emergency department were enrolled.Their arterial blood lactate levels were tested at admission and 6 hours later. Early lactate clearance rate was calculated as following:(lactate level of admission minus lactate level of 6 hours later) /lactate level of admission ×100 ％. Heart rate and blood pressure were recorded at admission,and the acute physiology and chronic health evaluationⅡ (APACHE Ⅱ ) score was evaluated in the first 24 hours.28 days after admission was the end of research.Patients were divided into survival group (n=59) and death group (n=23).Taking 10％ as cut-off,patients were divided into high lactate clearance (≥ 10％) group (n=59) and low lactate clearance (＜10％) group (n=23).Values of arterial blood lactate level,APACHE Ⅱ score and early lactate clearance to predict the prognosis of elderly septic patients were determined by ROC curves. Results Arterial blood lactate level was lower in survival group than death group[(2.4± 1.7)mmol/L vs.(3.9±3.2)mmol/L,P＜0.01].Early lactate clearance was higher in survival group than death group [(339.0 ± 28.0) ％ and (300.0 ± 81.0) ％,P ＜ 0.01].Mortality of high lactate clearance group was decreased as compared with low lactate clearance group [18.6％ (11/59) and 52.2％ (12/23),P＜0.01].The thresholds of early lactate clearance to predict mortality of elderly septic patients were 24.0％ (sensitivity 72.9％,specificity 65.2％) which was more valuable than APACHE Ⅱ score ( sensitivity 65.2 ％,specificity 57.6 ％). Conclusions Arterial blood lactate level and early lactate clearance were meaningful predictors for prognosis of elderly septic patients.