CAJ | 학술논문

目的评价乳酸清除率评估严重脓毒症患者早期液体复苏效果的可靠性.方法严重脓毒症患者142例,年龄28 ～ 87岁,性别不限.入ICU后静脉输注等渗晶体液,使患者6h内CVP≥8mmHg、MAP≥65 mmHg、中心静脉血氧饱和度(ScvO2)≥70％、尿量≥0.5 ml·kg-1 ·h-1行液体复苏治疗.按液体复苏治疗结局分为2组:存活组和死亡组.分别于液体复苏前即刻、液体复苏后6、12和24 h时,取中心静脉血样行血气分析,记录ScvO2;取外周静脉血样,测定乳酸浓度,计算乳酸清除率.结果与存活组比较,死亡组液体复苏后6、12和24 h时乳酸清除率降低(P＜0.05),ScvO2差异无统计学意义(P＞0.05).结论乳酸清除率可评估严重脓毒症患者早期液体复苏的效果.
목적 평개유산청제솔평고엄중농독증환자조기액체복소효과적가고성.방법 엄중농독증환자142례,년령28 ～ 87세,성별불한.입ICU후정맥수주등삼정체액,사환자6h내CVP≥8mmHg、MAP≥65 mmHg、중심정맥혈양포화도(ScvO2)≥70％、뇨량≥0.5 ml·kg-1 ·h-1행액체복소치료.안액체복소치료결국분위2조:존활조화사망조.분별우액체복소전즉각、액체복소후6、12화24 h시,취중심정맥혈양행혈기분석,기록ScvO2;취외주정맥혈양,측정유산농도,계산유산청제솔.결과 여존활조비교,사망조액체복소후6、12화24 h시유산청제솔강저(P＜0.05),ScvO2차이무통계학의의(P＞0.05).결론 유산청제솔가평고엄중농독증환자조기액체복소적효과.
Objective To evaluate the reliability of lactate clearance rate in evaluating the efficacy of early fluid resuscitation in the patients with severe sepsis.Methods One hundred and forty-two patients with severe sepsis,aged 28-87 yr,were enrolled in the study.Isotonic crystalloid fluid was infused after admission to ICU to maintain central venous pressure ≥ 8 mmHg,mean arterial pressure ≥ 65 mmHg,central venous oxygen saturation (ScvO2) ≥ 70％,and urine output ≥ 0.5 ml·kg 1 ·h-1 within 6 h.The patients were divided into 2 groups according to the treatment outcome:survival group and death group.Immediately before fluid resuscitation and at 6,12 and 24 h after fluid resuscitation,blood samples were collected from the central vein for blood gas analysis and ScvO2 was recorded.Blood samples were collected from the peripheral vein for determination of the concentration of lactate and lactate clearance rate was calculated.Results Compared with survival group,the lactate clearance rate was significantly decreased at 6,12 and 24 h after fluid resuscitation,and no significant change in ScvO2 was found in death group.Conclusion Lactate clearance rate can evaluate the efficacy of early fluid resuscitation in the patients with severe sepsis.