中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2012年
12期
1358-1362
,共5页
高伟波%曹宝平%陈子涛%朱继红
高偉波%曹寶平%陳子濤%硃繼紅
고위파%조보평%진자도%주계홍
高乳酸血症%乳酸性酸中毒%危重病%预后
高乳痠血癥%乳痠性痠中毒%危重病%預後
고유산혈증%유산성산중독%위중병%예후
Hyperlactaemia%Lactic acidosis%Critical illness%Prognosis
目的 探讨血乳酸水平和乳酸清除率对危重病患者预后的早期评估作用.方法 分析北京大学人民医院286例高乳酸血症患者的临床、实验室资料及预后情况,分析不同乳酸水平的病死率、APACHE Ⅱ评分差异；根据入院7d内的转归分为存活组、死亡组,比较两组pH、HCO3-、BE、Lac等参数的差异,并对严重高乳酸血症进行上述分析,比较存活与死亡组乳酸清除率、APACHE Ⅱ评分的差异；对严重高乳酸血症患者按照乳酸清除率分为高、低清除率组,比较两组间参数的差异.结果 按乳酸水平分层(≥2,＜4 mmol/L; ≥4,＜10mmol/L;≥10 mmol/L),其对应的病死率分别为14.04％、46.67％、78.79％,随着乳酸上升,pH失代偿比例上升,APACHEⅡ评分增加,病死率也上升.存活组与死亡组之间的乳酸、乳酸清除率、APACHE Ⅱ评分均差异有统计学意义(P＜0.01).高、低乳酸清除率组间治疗6h后APACHE Ⅱ评分、病死率差异具有统计学意义(P＜0.01)；两组乳酸和初始APACHE Ⅱ评分差异无统计学意义(P＞0.05).乳酸与APACHE Ⅱ评分呈正相关(r=0.868,P＜0.01),乳酸清除率与APACHE Ⅱ评分呈负相关(r=-0.823,P＜0.01).结论 乳酸分层、早期乳酸清除率对评估危重患者预后有重要价值,结合动态APACHEⅡ评分,三者能更好地指导临床治疗、评价预后.
目的 探討血乳痠水平和乳痠清除率對危重病患者預後的早期評估作用.方法 分析北京大學人民醫院286例高乳痠血癥患者的臨床、實驗室資料及預後情況,分析不同乳痠水平的病死率、APACHE Ⅱ評分差異；根據入院7d內的轉歸分為存活組、死亡組,比較兩組pH、HCO3-、BE、Lac等參數的差異,併對嚴重高乳痠血癥進行上述分析,比較存活與死亡組乳痠清除率、APACHE Ⅱ評分的差異；對嚴重高乳痠血癥患者按照乳痠清除率分為高、低清除率組,比較兩組間參數的差異.結果 按乳痠水平分層(≥2,＜4 mmol/L; ≥4,＜10mmol/L;≥10 mmol/L),其對應的病死率分彆為14.04％、46.67％、78.79％,隨著乳痠上升,pH失代償比例上升,APACHEⅡ評分增加,病死率也上升.存活組與死亡組之間的乳痠、乳痠清除率、APACHE Ⅱ評分均差異有統計學意義(P＜0.01).高、低乳痠清除率組間治療6h後APACHE Ⅱ評分、病死率差異具有統計學意義(P＜0.01)；兩組乳痠和初始APACHE Ⅱ評分差異無統計學意義(P＞0.05).乳痠與APACHE Ⅱ評分呈正相關(r=0.868,P＜0.01),乳痠清除率與APACHE Ⅱ評分呈負相關(r=-0.823,P＜0.01).結論 乳痠分層、早期乳痠清除率對評估危重患者預後有重要價值,結閤動態APACHEⅡ評分,三者能更好地指導臨床治療、評價預後.
목적 탐토혈유산수평화유산청제솔대위중병환자예후적조기평고작용.방법 분석북경대학인민의원286례고유산혈증환자적림상、실험실자료급예후정황,분석불동유산수평적병사솔、APACHE Ⅱ평분차이；근거입원7d내적전귀분위존활조、사망조,비교량조pH、HCO3-、BE、Lac등삼수적차이,병대엄중고유산혈증진행상술분석,비교존활여사망조유산청제솔、APACHE Ⅱ평분적차이；대엄중고유산혈증환자안조유산청제솔분위고、저청제솔조,비교량조간삼수적차이.결과 안유산수평분층(≥2,＜4 mmol/L; ≥4,＜10mmol/L;≥10 mmol/L),기대응적병사솔분별위14.04％、46.67％、78.79％,수착유산상승,pH실대상비례상승,APACHEⅡ평분증가,병사솔야상승.존활조여사망조지간적유산、유산청제솔、APACHE Ⅱ평분균차이유통계학의의(P＜0.01).고、저유산청제솔조간치료6h후APACHE Ⅱ평분、병사솔차이구유통계학의의(P＜0.01)；량조유산화초시APACHE Ⅱ평분차이무통계학의의(P＞0.05).유산여APACHE Ⅱ평분정정상관(r=0.868,P＜0.01),유산청제솔여APACHE Ⅱ평분정부상관(r=-0.823,P＜0.01).결론 유산분층、조기유산청제솔대평고위중환자예후유중요개치,결합동태APACHEⅡ평분,삼자능경호지지도림상치료、평개예후.
Objective To investigate the prognostic significance of serum lactate level and lactate clearance rate for critical illness patients.Methods Two hundred and eighty-six patients with hyperlactacidemia were investigated by analyzing the clinical data,laboratory data and outcomes.Comparison of mortality rate and APACHE Ⅱ score between different stratified levels of serum lactate was carried out.The blood pH,HCO3-,BE,and Lac were compared between survivors and non-survivors in terms of in-hospital death in seven days after admission.The above variables of blood gas analysis were studied in patients with severe hyperlactacidemia as well as the different lactate clearance rates and APACHE Ⅱ scores were compared between survivors and non-survivors.The mortality rates and APACHE Ⅱ scores were compared between high and low lactate-clearance rate groups.Results The mortality rates of different stratified levels of serum lactate (≥2,＜4 mmol/L; ≥4,＜ 10mmol/L; ≥ 10 mmoL/L) were 14.04％,46.67％,78.79％,respectively.As the serum level of lactate increased,the decompensation rate of pH,APACHE Ⅱ score and mortality rate increased consequently.Compared with non-survivors,survivors had a higher lactate clearance rate (P ＜ 0.01),and lower APACHE Ⅱ score (P ＜ 0.01).The high-clearance group had lower mortality rate and 6-hour APACHE Ⅱ score compared with the low-clearance group (P ＜ 0.01),but the initiate levels of serum lactate and APACHE Ⅱ scores were not noticeably different between the two groups (P ＞ 0.05).Serum lactate level had a significant positive relationship with APACHE Ⅱ score (r =0.868,P ＜ 0.01),but lactate clearance rate had a significant reverse relationship with APACHE Ⅱ score (r =-0.823,P ＜ 0.01).Conclusions Both serum lactate levels and early lactate clearance rate had high prognostic value for critical illness patients,and in combination with changes in APACHE Ⅱ score,they could guide clinical treatment and give precise evaluation of the prognosis.
