摘要
目的:探讨早期乳酸清除率对有创通气治疗危重病急性呼吸衰竭患者预后的评估作用。方法:回顾性分析石河子人民医院2013年1月至2014年1月重症医学科(ICU)收治的65例急性呼衰患者。对65例患者进行急性生理学及慢性健康状况评价Ⅱ(APACHEⅡ)评分,测定治疗前、治疗后6h动脉血乳酸及动脉血气,计算6h乳酸清除率。根据患者预后分为存活组(50例)和死亡组(15例),以动脉血乳酸清除率10%为界限,分为高乳酸清除率(≥10%)组(46例)和低乳酸清除率(<10%)组(19例)。比较存活组和死亡组、高乳酸清除率组和低乳酸清除率组之间相关数值的差异。结果:存活组与死亡组、高乳酸清除率组与低乳酸清除率组患者比较,治疗前动脉血乳酸、APACHE II评分、p H值、Pa O2、Pa CO2及氧合指数等差异均无统计学意义;而治疗6h后,存活组与死亡组、高乳酸清除率组与低乳酸清除率组患者比较动脉血乳酸、Pa O2、Pa CO2及氧合指数的差异均有统计学意义(均<0.05),但是p H值、APACHEⅡ评分两组间比较差异均无统计学意义;存活组6h乳酸清除率(27%±9%)明显高于死亡组乳酸清除率(12%±4%),有统计学差异(<0.05);高乳酸清除率组病死率(15.21%)明显低于低乳酸清除率组(42.10%),差异有统计学(<0.05)。结论:早期乳酸清除率可作为判断有创机械通气治疗重症急性呼吸衰竭患者预后的一个指标。
Objective： To explore the prognostic value of early lactate clearance rate in severe acute respiratory failure patients treated by invasive mechanical ventilation.Methods：Data from 65 acute respiratory failure patients in Intensive Care Unit Department（ICU）of the People＇s hospital of SHI He-zi. January 2013 to January 2014 were retrospectively analyzed.The acute physiology and chronic health evaluation Ⅱ（APACHE II）score was evaluated,6 h arterial blood lactate and arterial blood gas analysis were measured before and after the treatment.and then 6h lactate clearance rate were calculated in all the 65 patients.Patients were divided into survival group（n=50） and death group（n=15）by the outcome,The high lactate clearance rate group（46 cases）was defined as a lactate clearance rate ≥10% and the low lactate clearance rate group（19 cases）with a lactate clearance rate10%.Data were compared between the survival group and the death group.the high lactate clearance rate group and the low lactate clearance group. Results：There were no statistical differences in arterial blood lactate,APACHE II score,p H value,PaO2,Pa CO2 and oxygenation index between the survival group and the death group or between the high lactate clearance rate group and the low lactate clearance rate group before the treatment.There were statistical differences in arterial blood lactate,Pa O2,Pa CO2 and oxygenation index between groups 6h after the treatment（P〈0.05）except for p H values and APACHE Ⅱ score.The 6 hour lactate clearance rate of the survival group（27%±9%） was significantly higher than that of the death group（12%±4%）,（P〈0.05）.Mortality of the high lactate clearance rate group（15.21%） was significantly lower than that of the low lactate clearance rate group（42.10%）（P〈0.05）.Conclusion：Early lactate clearance rate can be used as an important reference index for prognosis of severe acute respiratory failure patients treated by invasive mechanical ventilation.
出处
《农垦医学》
2015年第2期146-150,共5页
Journal of Nongken Medicine
关键词
乳酸清除率
有创机械通气
危重病
急性呼吸衰竭
预后
Lactate clearance rate
Invasive mechanical ventilation
Critical illness
Acute respiratory failure
Prognosis
