| 摘要: |
| 目的探讨动态监测血乳酸水平评估危重症患者预后的价值。方法收集194例ICU患者的临床资料，根据患者的预后分为存活组（129例）和死亡组（65例），统计并分析入ICU时、治疗后4、12、24h各时点血乳酸水平及4~12h、12~24h时段的乳酸水平变化情况及乳酸清除率，并与患者的预后进行相关性分析，绘制ROC曲线，评价不同时点乳酸水平及乳酸清除率对预后的预测价值。结果存活组各时点乳酸水平均低于死亡组（均P＜0.05），存活组在入ICU后乳酸水平逐渐下降；死亡组在入ICU后4h内乳酸呈下降趋势，但随后逐渐上升；存活组在入ICU12~24h间乳酸清除率明显高于死亡组（P＜0.01）；ROC曲线分析显示：乳酸最高值的ROC曲线AUC最大为0.802，以临界值4.45mmol/L分为高乳酸组和低乳酸组，高乳酸组病死率（60.5%）明显高于低乳酸组（16.1%）（P＜0.01）。结论高血乳酸水平及入ICU24h乳酸的变化趋势提示危重症患者预后不佳，入ICU12~24h乳酸清除率对早期评估危重症患者预后具有预测价值。 |
| 关键词: 危重症患者 血乳酸 乳酸最高值 乳酸清除率 预后 |
| DOI：10.12056/j.issn.1006-2785.2017.39.7.2016-568 |
| 分类号: |
| 基金项目: |
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| Dynamic monitoring of serum lactate level in evaluation of prognosis for critically ill patients |
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SHI Qiuling, XIE Bo, ZHENG Xia
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Huzhou Central Hospital
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| Abstract: |
| Objective To investigate the prognostic value of dynamic monitoring serum lactate in critically ill patients. Methods One hundred and ninety four critically ill patients admitted in ICU were enrolled in the study, including 129 survival cases and 65 fatal cases. The clinical data of patients, including sex, age, diagnosis, serum lactate at admission, 4h, 12h, 24h after admission and the maximum level, were retrospectively analyzed. The trend of changes in serum lactate at each time points and the lactate clearance rate were compared between survival and fatal groups. The receiver operating characteristic (ROC) curve was plotted to assess the value of serum lactate and the lactate clearance rate at different time points for predicting the outcome. Results There were no differences in sex and age between survival and fatal groups (P ＞0.05). In the survival group, the serum lactate levels were gradually declined and lower than those in fatal group at all time points. In fatal group, the serum lactate levels were declined in first 4h, and then gradually increased. The clearance rate of lactate between 12h to 24h in survival group was significantly higher than that in fatal group. The ROC curve analysis showed that the area under ROC curve (AUC) of the maximum serum lactate level was the largest (0.802). Taking the cut-off value of 4.45mmol/L in lactate concentration, the
mortality in increased lactate group was significantly higher than that in low lactate group [60.5%(46/76) vs. 16.1%(19/118), P＜ 0.001）. Conclusion High lactate level and increasing trend in lactate level at the first 24 h indicates poor prognosis, and lactate clearance rate in 12-24 h has prognostic value for early assessment of critically ill patients. |
| Key words: Critically ill patients Serumlactate The maximum serum lactate Lactate clearance rate Prognosis |
