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乳酸及乳酸清除率对烧伤休克患者预后的预测价值
作者:于丽  陈向军  董学会  米丽丽  马俐华  梁丽枝  段文杰  田洪榛  谢生茂 
单位:中国人民解放军联勤保障部队第九六九医院 重症医学科, 内蒙古 呼和浩特 010051
关键词:烧伤休克期 乳酸 乳酸清除率 预后 
分类号:R644
出版年·卷·期(页码):2020·48·第二期(167-171)
摘要:

目的: 探讨血乳酸及乳酸清除率对烧伤休克期患者预后的预测价值。方法: 对我院烧伤科收住的88例休克期血乳酸>2.0 mmol/L的患者进行回顾性分析,按住院28 d是否存活将患者分为存活组(48例)和死亡组(40例)。测定入院时(0 h)及入院后6 h、12 h、24 h和72 h血乳酸水平,同时记录血氧分压,并进行急性生理与慢性健康评分Ⅱ。分析0 h静脉血乳酸的水平、PO2与APACHEⅡ评分的相关性;分析各时间点的乳酸清除率与预后的关系;分析血乳酸水平、乳酸清除率、APACHEⅡ评分和28天死亡情况的关系。结果: 死亡组患者0 h、6 h、12 h、24 h和72 h血乳酸水平均显著高于存活组。所有烧伤休克患者入院时的血乳酸水平与入院时的APACHE II评分呈现出明显的相关性(P<0.01),而血氧分压与APACHE II评分无相关性(P>0.05)。多因素logistic回归分析结果表明,6 h和12 h的乳酸清除率可作为预后因素,独立对预后进行评价。结论: 动态监测血乳酸对烧伤休克期患者具有重要意义,持续性高乳酸血症预示预后不良,6 h和12 h乳酸清除率可用作预后指标。

Objective: To investigate the prognosis value of lactate and lactate clearance rate in patients during burn shock stage. Methods: 88 patients with blood lactate>2.0 mmol/L during burn shock in the hosptital burn unit were retrospectively analyzed. The patients were divided into survivor group (n=48) and death group (n=40) according to whether they survived on 28th day. Blood lactate levels were measured at admission (0 h) and at 6 h, 12 h, 24 h and 72h after admission. The partial pressure of blood oxygen was recorded, as well as the acute physiology and chronic health evaluation (APACHE Ⅱ). The correlation of the lactate blood level at 0 h, PO2 between APACHE Ⅱ scores, and the relationship between lactate clearance and prognosis was analyzed at each time point. Results: Blood lactate levels at 0 h, 6 h, 12 h, 24 h and 72 h in the death group were significantly higher than those in the surviving group, resoectively. Lactate levels of patients during burn shock on admission were significantly associated with APACHE II scores (P<0.01), but not with partial pressure of oxygen (P>0.05). Multivariate logistic regression analysis showed that the lactate clearance rate at 6 h and 12 h could be used as a prognostic factor to independently evaluate the prognosis. Conclusions: The dynamic monitoring of blood lactate is of great significance in patients with burn shock. Persistent hyperlactacidemia indicates a poor prognosis. The lactic acid clearance rate at 6 h and 12 h may be used as indices for prognostic evaluation.

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