CAJ | 학술논문

目的：分析急性中毒患者病程动脉血乳酸（ lactate， Lac ）值及6 h 乳酸清除率（ lactate clearance rate，LCR）的特点，探讨与急性中毒患者预后的关系。方法对2009年1月至2013年12月住于福建省立医院急危重症监护病房（ EICU）的急性中毒患者临床资料进行回顾性分析，根据服毒后28 d的转归将患者分为存活组及死亡组进行对照研究，判定入院初始动脉血Lac及6 h LCR对于患者预后的预测价值。结果共纳入符合标准的282名急性中毒患者，年龄15～71岁，平均年龄（33．67±12．52）岁；男性142例，女性140例；服毒至就诊时间4～132 h之间，平均就诊时间（17．25±30．58） h。经随访服毒后28 d死亡76例，存活206例。死亡率26．95％；死亡组与存活组在年龄、性别、服毒至就诊时间比较差异无统计学意义；死亡组的入院初始动脉Lac值、APACHEII评分值高于存活组（P＜0．001）；死亡组的6 h乳酸清除率（ LCR）低于存活组（ P＜0．001）；入院初始动脉Lac值＜4 mmol／L组的死亡率低于入院初始动脉Lac值≥4 mmol／L组（P＜0．001）；6 h LCR＜10％组的死亡率高于6 h LCR≥10％组（P＜0．001）；根据APACHEII评分值进行分组（0＝＜10分，1＝10～19，2＝20～29，3＝≥30），评分高的分组死亡率高于评分低的分组（P＜0．001）；且评分高的分组6 h LCR低于评分低组（P＜0．001）。结论急性中毒患者动脉血Lac值尤其是6 h LCR与患者预后具有良好相关性，可作为预测患者预后的较好指标。
목적：분석급성중독환자병정동맥혈유산（ lactate， Lac ）치급6 h 유산청제솔（ lactate clearance rate，LCR）적특점，탐토여급성중독환자예후적관계。방법대2009년1월지2013년12월주우복건성립의원급위중증감호병방（ EICU）적급성중독환자림상자료진행회고성분석，근거복독후28 d적전귀장환자분위존활조급사망조진행대조연구，판정입원초시동맥혈Lac급6 h LCR대우환자예후적예측개치。결과공납입부합표준적282명급성중독환자，년령15～71세，평균년령（33．67±12．52）세；남성142례，녀성140례；복독지취진시간4～132 h지간，평균취진시간（17．25±30．58） h。경수방복독후28 d사망76례，존활206례。사망솔26．95％；사망조여존활조재년령、성별、복독지취진시간비교차이무통계학의의；사망조적입원초시동맥Lac치、APACHEII평분치고우존활조（P＜0．001）；사망조적6 h유산청제솔（ LCR）저우존활조（ P＜0．001）；입원초시동맥Lac치＜4 mmol／L조적사망솔저우입원초시동맥Lac치≥4 mmol／L조（P＜0．001）；6 h LCR＜10％조적사망솔고우6 h LCR≥10％조（P＜0．001）；근거APACHEII평분치진행분조（0＝＜10분，1＝10～19，2＝20～29，3＝≥30），평분고적분조사망솔고우평분저적분조（P＜0．001）；차평분고적분조6 h LCR저우평분저조（P＜0．001）。결론급성중독환자동맥혈Lac치우기시6 h LCR여환자예후구유량호상관성，가작위예측환자예후적교호지표。
Objective We conducted a retrospective chart review to investigate how arterial lactate ( Lac) and 6 -h lactate clearance rate ( LCR ) correlate with prognosis in patients with acute poisoning. Methods We reviewed the records of 282 patients (142 males and 140 females, with average age of 33.67 ± 12.52 years old (ranging from 15 to 71) admitted to the Emergency Intensive Care Unit of Fujian Provincial Hospital between January 2009 and December 2013.Patients were divided into two groups: those who survived>28days after admission (n=206), and those who died ≤28 days of admission (n=76).We evaluated the prognostic value of arterial Lac and 6-h LCR during the acute stage of poisoning.Results The average length of time from poisoning to arriving at the emergency department was 17.25 ±30.58 h (ranging from 4 to 312h). Total mortality was 26.95%.There were no marked differences between the two groups in age, gender, and time from poisoning to diagnosis.The initial value of admission arterial Lac and APACHEII scores in the nosurvival death group is higher than the survival group(P<0.001);6 h lactate clearance rate (LCR) in the nosurvival death group is less than the survival group (P<0.001).Initial arterial Lac value <4mmol /L group of mortality was lower than the initial arterial Lac value≥4mmol /L group (P<0.001);6h LCR <10%group of mortality was higher than 6 h LCR≥10%group (P<0.001);Grouped according APACHEII scores, score high mortality rate is higher than the score low packet (P<0.001);and score high packet 6 h LCR score was lower than the low group (P<0.001).Conclusions For patients in the acute poisoning, arterial Lac and 6 -h LCR are closely related to the prognosis and may serve as prognostic factors.