中外医疗2010NO.04CHINAFOREIGNMEDICALTREATMENT论著资料显示严重脓毒症发病率达50~300/10万,病死率达30%~50%,是ICU患者主要死亡原因,给人类带来巨大经济负担。若能早期评估脓毒症患者严重程度,积极指导临床治疗对改善患者预后有重要意义。临床工作中我们常通过监测严重脓毒症患者各器官功能来判断病情严重程度,当出现器官功能不全时病情往往已较重,而动脉乳酸是近些年来提出相对较新的监测指标,它可以反映组织细胞灌注和代谢情况,可较早期反映病情严重程度。本文通过监测我院ICU收治的57例严重脓毒症患者动脉乳酸和6h乳酸清除率结合APACHE,Ⅱ探讨其对严重脓毒症患者病情的预测价值。1资料与方法1.1一般资料选择我院ICU2008年6月至2009年6月临床资料完整的严重脓严重脓毒症患者动脉乳酸动态监测的临床意义①胡慧卿寿松涛*(天津医科大学总医院急诊科天津300052【摘要】目的探讨严重脓毒症患者动脉乳酸及乳酸清除率的变化与预后的关系。方法对我院收治的57例严重脓毒症患者测定入院和入院6h动脉乳酸,计算6h乳酸清除率。根据24h内最差生命体征、生化指标、年龄及是否手术计算APACHEⅡ。据患者预后分为存活组和死亡组,比较2组动脉乳酸及6h乳酸清除率;绘制动脉乳酸及其清除率、APACHEⅡ的ROC曲线,比较其判断预后的价值;据APACHEⅡ≤分为20分组及>20分组,用独立样本t检验比较2组动脉乳酸及乳酸清除率;用Pearson相关分析APACHEⅡ与动脉乳酸及乳酸清除率相关性;应用Logistic回归分析影响严重脓毒症患者预后的独立危险因素。结果死亡组动脉乳酸(10.74±2.29明显高于存活组(5.24±2.89,死亡组患者乳酸清除率(10.69±3.72明显低于存活组(34.00±13.68,有统计学差异(P<0.01;应用APACHEⅡ判断严重脓毒症患者预后的ROC曲线下面积AUC为0.869,6h动脉乳酸AUC为0.951,6h动脉乳酸清除率AUC为0.942,差异有统计学意义(P<0.000;APACHE>20Ⅱ≤分组较20分组动脉乳酸升高,6h动脉乳酸清除率降低,有统计学差异(P<0.01;Pearson相关分析示初始动脉乳酸及6h动脉乳酸均与APACHEⅡ呈正相关(r=0.741,0.754,P<0.000,6h动脉乳酸清除率与APACHEⅡ呈负相关(r=-0.618,P<0.000;Logistic回归分析示6h乳酸清除率及APACHEⅡ为严重脓毒症患者预后独立危险因素。结论随着APACHEⅡ评分的增高,动脉乳酸也相应增高,且6h动脉乳酸清除率低者,病情愈严重预后愈差。早期动态监测严重脓毒症患者动脉乳酸及其清除率是判断病情严重程度和预后的良好方法,6h动脉乳酸清除率是预测严重脓毒症患者预后的有效指标。【关键词】严重脓毒症动脉乳酸乳酸清除率APACHEⅡ评分【】R631【文献标识码】A【】1674-0742(201002(a-0020-04TheClinicalSignificanceofMonitoringArterialBloodLacticAcidDynamicinPatientswithSevereSepsisHUHuiqingSHOUSongtaoTianjinMedicalUniversityGenenalhospital,Tianjin300052,China【Abstract】ObjectiveObservechangeofarterialbloodlacticacidandits6hclearanceinpatientswithseveresepsis,discussofclinicalsignificanceonprognosis.MethodsThe57patientswerecollectedforLACdetect,monitoritwhenadmittedandafter6h,calculateclearance.Wecollectedclinicalvariablesin24hours,calculateAPACHE.Patientsweredividedintodeadandsurvivalgroup.CalculateLACand6hclearanceoftwogroups.ⅡWeuseROCanalysisLACandAPACHEforprognosis.Patientsweredividedinto>20and≤20scoregroup,calⅡculatedifferenceofLACand6hclearance.WecalculatecorrelationofAPACHEandLACwithPearson.WefiⅡndindependentriskfactorswithlogisticregression.ResultsTherearesignificantdifferenceinLACanditsclearance,LACofdeadgroupishigherobviously.UnderROCcureof6hLACwas0.951,APACHEwas0.869;LACoⅡfAPACHE>20groupwashigher,and6hclearancewaslower;PearsoncorrelationprovedLACwaspositivecoⅡrrelatedwithAPACHE,while6hclearancewasnegative.ⅡPerforminglogisticregressionwefound6hLACclearanceandAPACHEaretwoindependentriskfactorⅡsforprognosis.ConclusionThehigherAPACHEandLAC,thelower6hLACclearance,theworsetheprognos...