东南大学学报（医学版）
東南大學學報（醫學版）
동남대학학보（의학판）
JOURNAL OF SOUTHEAST UNIVERSITY(MEDICAL SCIENCE EDITION)
2015年
1期
76-79
,共4页
朱宝华%江洁%孙峰%罗倩
硃寶華%江潔%孫峰%囉倩
주보화%강길%손봉%라천
乳酸清除率%APACHEⅡ评分%重症肺炎%预后
乳痠清除率%APACHEⅡ評分%重癥肺炎%預後
유산청제솔%APACHEⅡ평분%중증폐염%예후
lactate clearance rate%APACHE Ⅱ score%severe pneumonia%prognosis
目的：：探讨早期乳酸清除率和急性生理学和慢性健康状况Ⅱ( APACHEⅡ)评分对老年重症肺炎患者预后的临床意义。方法：对重症医学科收治的47例老年重症肺炎患者，平均年龄(83.1±8.4)岁，分别于入院时和明确诊断后6 h测定动脉血乳酸，计算乳酸清除率。在患者入院第1个24 h内进行APACHEⅡ评分。以患者入院后28 d 预后为研究终点，将患者分为存活组和死亡组，比较两组患者早期乳酸清除率及APACHEⅡ评分。根据明确诊断后6 h乳酸清除率将患者分为高乳酸清除率组(乳酸清除率≥10%)和低乳酸清除率组(乳酸清除率<10%)，比较两组患者APACHEⅡ评分、机械通气率、病死率。采用受试者工作特征( ROC)曲线分析乳酸清除率预测老年重症肺炎患者预后的价值。结果：存活组和死亡组的乳酸清除率分别为(19.7±6.4)%和(7.7±10.1)%，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26.7%(8/30)和58.8%(10/17)，高乳酸清除率组低于低乳酸清除率组(P<0.05)；乳酸清除率预测老年重症肺炎患者28 d病死率最佳临界点为20%，敏感性68.9%，特异性67.9%。结论：早期乳酸清除率与APACHEⅡ评分正相关，两者可作为判断老年重症肺炎患者预后的指标。
目的：：探討早期乳痠清除率和急性生理學和慢性健康狀況Ⅱ( APACHEⅡ)評分對老年重癥肺炎患者預後的臨床意義。方法：對重癥醫學科收治的47例老年重癥肺炎患者，平均年齡(83.1±8.4)歲，分彆于入院時和明確診斷後6 h測定動脈血乳痠，計算乳痠清除率。在患者入院第1箇24 h內進行APACHEⅡ評分。以患者入院後28 d 預後為研究終點，將患者分為存活組和死亡組，比較兩組患者早期乳痠清除率及APACHEⅡ評分。根據明確診斷後6 h乳痠清除率將患者分為高乳痠清除率組(乳痠清除率≥10%)和低乳痠清除率組(乳痠清除率<10%)，比較兩組患者APACHEⅡ評分、機械通氣率、病死率。採用受試者工作特徵( ROC)麯線分析乳痠清除率預測老年重癥肺炎患者預後的價值。結果：存活組和死亡組的乳痠清除率分彆為(19.7±6.4)%和(7.7±10.1)%，差異有統計學意義(P<0.01)；高乳痠清除率組和低乳痠清除率組28 d病死率分彆為26.7%(8/30)和58.8%(10/17)，高乳痠清除率組低于低乳痠清除率組(P<0.05)；乳痠清除率預測老年重癥肺炎患者28 d病死率最佳臨界點為20%，敏感性68.9%，特異性67.9%。結論：早期乳痠清除率與APACHEⅡ評分正相關，兩者可作為判斷老年重癥肺炎患者預後的指標。
목적：：탐토조기유산청제솔화급성생이학화만성건강상황Ⅱ( APACHEⅡ)평분대노년중증폐염환자예후적림상의의。방법：대중증의학과수치적47례노년중증폐염환자，평균년령(83.1±8.4)세，분별우입원시화명학진단후6 h측정동맥혈유산，계산유산청제솔。재환자입원제1개24 h내진행APACHEⅡ평분。이환자입원후28 d 예후위연구종점，장환자분위존활조화사망조，비교량조환자조기유산청제솔급APACHEⅡ평분。근거명학진단후6 h유산청제솔장환자분위고유산청제솔조(유산청제솔≥10%)화저유산청제솔조(유산청제솔<10%)，비교량조환자APACHEⅡ평분、궤계통기솔、병사솔。채용수시자공작특정( ROC)곡선분석유산청제솔예측노년중증폐염환자예후적개치。결과：존활조화사망조적유산청제솔분별위(19.7±6.4)%화(7.7±10.1)%，차이유통계학의의(P<0.01)；고유산청제솔조화저유산청제솔조28 d병사솔분별위26.7%(8/30)화58.8%(10/17)，고유산청제솔조저우저유산청제솔조(P<0.05)；유산청제솔예측노년중증폐염환자28 d병사솔최가림계점위20%，민감성68.9%，특이성67.9%。결론：조기유산청제솔여APACHEⅡ평분정상관，량자가작위판단노년중증폐염환자예후적지표。
Objective:To explore the clinical prognostic significance of early lactate clearance rate and APACHEⅡscore in elderly severe pneumonia patients. Methods:47 elderly severe pneumonia patients who were admitted into ICU were enrolled. The average age was (83. 1 ± 8. 4) years old. Their arterial blood lactate levels were tested at admission and 6 hours later for calculating early lactate clearance rate. 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 and death group. Taking 10% as cut-off, patients were divided into high lactate clearance rate(≥10%) group and low lactate clearance rate( <10%) group. Values of APACHEⅡscore and early lactate clearance rate to predict the prognosis of elderly severe pneumonia patients were determined by ROC curves. Results: Early lactate clearance rate was higher in survival group than that in death group[(19.7 ± 6. 4)% vs(7. 7 ± 10. 1)%,P <0. 01]. Mortality of high lactate clearance rate group was decreased as compared with low lactate clearance rate group [ ( 26 . 7%( 8/30 ) vs 58 . 8%( 10/17 ) , P <0 . 05 ] . The thresholds of early lactate clearance rate to predict mortality of elderly severe pneumonia patients were 20 . 0%( sensitivity 68 . 9%, specificity 67 . 9%) . Conclusions: There is a positive correlation between early lactate clearance rate and APACHE Ⅱ score, which are meaningful predictors for prognosis of elderly severe pneumonia patients.
