摘要
目的:探讨重症监护病房(ICU)内血乳酸增高的危重病患者的乳酸水平变化情况与7d、28d预后的关系。方法:收集ICU内动脉血乳酸水平升高的患者共133例,比较7d、28d的病死率。按7d、28d存活或死亡情况分组观察一般资料、乳酸指标(入ICU乳酸高值,8h、24h乳酸清除率)、住ICU天数、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。分别按入院乳酸高值分组、按8h、24h乳酸清除率分组、按高乳酸时间分组比较各组患者的一般资料、APACHEⅡ评分、7d和28d病死率。结果:住ICU乳酸升高患者28d病死率较7d病死率明显升高(P<0.01)。7d、28d死亡组患者乳酸值、APACHEⅡ评分均显著高于生存组(P<0.05、0.01),乳酸8h清除率、24h清除率均显著低于生存组(P<0.01)。严重乳酸酸中毒组7d病死率、A-PACHEⅡ评分明显高于高乳酸血症组(P<0.01、0.05),28d病死率无明显差异;而高乳酸血症组与乳酸酸中毒组之间观察值均无明显差异。各高清除率组与低清除率组比较,7d、28d病死率均明显降低(P<0.01),各中、低清除率组之间比较仅24h低清除率组28d病死率较中清除率组明显升高(P<0.01),其余各观察值均无明显差异。高乳酸时间>8h组、>24h组7d、28d病死率均较<8h组明显升高(P<0.01),且28d病死率较7d病死率组明显升高(P<0.05)。结论:ICU病房内血乳酸水平增高的危重病患者28d的总体病死率比7d病死率明显增加。入院血乳酸水平、乳酸清除率、高乳酸时间均是评估患者预后的良好指标,而且随着高乳酸时间的延长,28d病死率比7d病死率明显增高,在8h内将血乳酸降至正常范围内可能改善危重患者的预后。
Abstract Objective.. To study the relationship between the change of blood lactate level and the prognosis of critically ill patients in intensive care unit（ICU）. Method：One hundred and thirty-three cases of patients with ele- vated arterial blood lactate levels in ICU were collected in Our study. The mortality of 7 d and 28 d was analyzed. All the patients were grouped according to the survival of 7 d, 28 d, and the general information,lactate index （peak lactate level in ICU,8 h,24 h lactate clearance rate） ,the clays that stay in ICU,acute physiology and chronic health evaluation score l] （APACHE ]I ） were recorded and compared. The patients were grouped according to peak lac- tate level,and the lactate clearance rate at 8 h or 24 h,the duration of high lactate,the differences in their general information,APACHE l] score,mortality at 7 d and 28 d were compared. Result：The mortality of patients with lactate increase in ICU was significantly higher in 28d than in 7 d （33.08~ vsl8.05 %, P%0.01）. The peak lactate level,APACHE l] of 7 d,28 d in death group were significantly higher than that of survival group （P%0.05,0. 01）. The 8 h,24 h lactate clearance rate of the death group were significantly lower than that of survival group （P %0.01）. The 7 d mortality, APACHE II score of the severe lactic acidosis group were significantly higher than that of high lactate group （P%0. 01,0. 05）. But the 28 d mortality has no significant difference. There were no sta- tistically differences in 7 d and 28 d mortality,APACHE.l] score between the high lactate group and the lactic aci- dosis group. The 7 d and 28 d mortality of the high lactate clearance rate group were significantly lower than that of the low clearance rate group （P%0.01）. The 28 d mortality of the 24 h low clearance rate group was significant- ly higher than that of the 24 h secondary clearance rate group （P%0.01）. The 7 d,28 d mortality of high lactate〉 8 h group and 〉24 h group were significantly higher than of the %8 h group （P%0.01） ,and the 28 d mortality was significantly higher than 7 d mortality（P%0.05）. Conclusion： The overall mortality of 28 d of patients with lactate increase in ICU was significantly high than 7 d. The peak lactate level, lactate clearance rate, high lactate time are good indicators to evaluate patients prognosis. With the extension of the high lactate time,28 d mortalitywas significantly higher than 7 d-mortality, blood lactate level fell within normal limits in 8 h may improve the prognosis of critically ill patients.
出处
《临床急诊杂志》
CAS
2013年第1期20-23,26,共5页
Journal of Clinical Emergency
关键词
乳酸
乳酸清除率
高乳酸时间
预后
lactate
lactate clearance rate
duration of hyperlactatemia
prognosis
