CAJ | 학술논문

目的：探讨重症肺炎患者早期动脉血乳酸清除率、中心静脉血氧饱和度（ScvO2）的监测价值。方法回顾性研究2012年1月—2013月12月56例重症肺炎患者，入科即刻和6 h时测定动脉血乳酸浓度和早期ScvO2，计算6 h乳酸清除率，并进行急性生理与慢性健康（APACHEⅡ）评分，根据APACHEⅡ评分将患者分为3组：10～＜20分组（A组），20～＜30分组（B组），≥30分组（C组），比较不同组别早期乳酸清除率和ScvO2的差别，并分析其与预后的关系。结果①B组初始动脉血乳酸较A组高，C组初始动脉血乳酸较B组高，但组间差异均无统计学意义（均 P＞0．05）；②B组早期6 h乳酸清除率、ScvO2均较A组低，差异有统计学意义（ P＜0．05），C组早期6 h乳酸清除率、ScvO2均低于B组，差异有统计学意义（ P＜0．05）。③B组病死率高于A组，C组病死率高于B组，差异均有统计学意义（均 P＜0．05）；④死亡组APACHE Ⅱ评分高于存活组，早期动脉血乳酸清除率和ScvO2水平低于存活组，差异均有统计学意义（均 P＜0．05）；⑤APACHEⅡ评分与早期乳酸清除率呈显著负相关（r＝0．661，P＜0．01），与早期ScvO2水平呈显著负相关（r＝0．579，P＜0．01）。结论早期动脉血乳酸清除率及ScvO2水平是反映重症肺炎患者病情严重程度和预测患者转归的参考指标。
목적：탐토중증폐염환자조기동맥혈유산청제솔、중심정맥혈양포화도（ScvO2）적감측개치。방법회고성연구2012년1월—2013월12월56례중증폐염환자，입과즉각화6 h시측정동맥혈유산농도화조기ScvO2，계산6 h유산청제솔，병진행급성생리여만성건강（APACHEⅡ）평분，근거APACHEⅡ평분장환자분위3조：10～＜20분조（A조），20～＜30분조（B조），≥30분조（C조），비교불동조별조기유산청제솔화ScvO2적차별，병분석기여예후적관계。결과①B조초시동맥혈유산교A조고，C조초시동맥혈유산교B조고，단조간차이균무통계학의의（균 P＞0．05）；②B조조기6 h유산청제솔、ScvO2균교A조저，차이유통계학의의（ P＜0．05），C조조기6 h유산청제솔、ScvO2균저우B조，차이유통계학의의（ P＜0．05）。③B조병사솔고우A조，C조병사솔고우B조，차이균유통계학의의（균 P＜0．05）；④사망조APACHE Ⅱ평분고우존활조，조기동맥혈유산청제솔화ScvO2수평저우존활조，차이균유통계학의의（균 P＜0．05）；⑤APACHEⅡ평분여조기유산청제솔정현저부상관（r＝0．661，P＜0．01），여조기ScvO2수평정현저부상관（r＝0．579，P＜0．01）。결론조기동맥혈유산청제솔급ScvO2수평시반영중증폐염환자병정엄중정도화예측환자전귀적삼고지표。
Objective To explore the value of early arterial blood lactate clearance rate and central venous oxygen saturation (ScvO2 ) monitoring in patients with severe pneumonia .Methods A total of 56 patients with severe pneumonia treated during the period from January 2012 to December 2013 were reviewed retrospectively .The arterial blood lactate concentration and ScvO2 were determined immediately after admission to hospital and 6 hours after admission to calculate the 6‐hour lactate clearance rate .APACHE II score was evaluated at the same time .The patients were divided into three groups according to APACHE II score:10 to <20 (group A) ,20 to <30 (group B) ,≥30 (group C) .The three groups were compared in terms of early arterial blood lactate clearance rate and ScvO2 and estimate their association with the prognosis of patients .Results The initial arterial blood lactate concentration did not show significant difference between the three groups (P>0 .05) .The early lactate clearance rate and ScvO2 at 6 hours in group C were significantly lower than in group B .The values in group B were significantly lower than in group A (P<0 .05) .The mortality rate in group C was significantly higher than in group B ,and the mortality rate in group B was significantly higher than in group A (P<0 .05) .The APACHE II score of the dead patients was higher than that of the suevivors ,but early lactate clearance rate and ScvO2 level were lower than those of the survivors (P<0 .05) .APACHE II score was negatively correlated to early lactate clearance rate (r=0 .661 ,P<0 .01) and early ScvO2 level (r=0 .579 , P< 0 .01) .Conclusions Early lactate clearance rate and ScvO2 level are good indicators to reflect the severity of disease and predict the outcome in the patients with severe pneumonia .