摘要
目的:探讨早期乳酸清除率与重症颅脑损伤预后的相关性。方法:回顾分析重症加强治疗病房(ICU)的重症颅脑损伤患者80例的病历资料。在入住ICU后即刻、治疗12 h抽取动脉血进行血气分析,主要观察血乳酸变化,记录血乳酸0、12 h数值,观察入ICU 24 h的急性生理与慢性健康评分(APACHEⅡ)、格拉斯哥昏迷评分(GCS评分),计算12 h血乳酸清除率;以患者预后即30 d存活率将其分为恶化(多脏器功能衰竭死亡或加重放弃治疗)组和好转(存活稳定)组,比较两组患者早期乳酸清除率、APACHEⅡ评分、格拉斯哥昏迷评分(GCS评分)的差异与预后之间的关系;同时以12 h乳酸清除率10%为界限,分为低乳酸清除率组和高乳酸清除率组,比较两组患者预后的差异及其与预后间的关系。结果:低乳酸清除率组与高乳酸清除率组预后差异存在统计学意义(P<0.05);好转组早期乳酸清除率明显高于恶化组;乳酸清除率与APACHEⅡ评分呈负相关,与GCS评分呈正相关。结论:早期血乳酸清除率与重症颅脑损伤存在相关性,结合APACHEⅡ评分与GCS评分可作为预测病情预后的重要指标。
Objective： To explore correlation between early lactate clearance rate and prognosis of patients with severe craniocerebral injury. Methods： The clinical data of 80 cases with severe craniocerebral injuries in the intensive care unit（ ICU） were retrospectively analyzed. Arterial gas analysis was immediately executed at 0： 00 and 12： 00 post-ICU. In addition to taking into account other important indicators,the changes in blood lactic acid were observed,the blood lactate levels at 0 and 12： 00 post-ICU were recorded,the APACHE Ⅱ score and Glasgow coma score（GCS score） 24： 00 post-ICU were observed,the 12-hour blood lactate clearance rate was calculated. All the patients were divided into worse group（ multiple organ failure,death or abandoning treatment owing to aggravation） and improvement group（ survival stable） according to the 30-day survival rate. The differences of early lactic acid clearance,APACHE Ⅱ score and Glasgow coma score（ GCS score） between the two groups were compared with the prognosis. Results：There was a significantly statistical difference in the prognosis among the patients with the high lactate clearance rate and those with the low lactate clearance rate. The lactate clearance rate in the early stage of the improvement group was significantly higher than that in the worse group. The lactate clearance rate was negatively correlated with the APACHE Ⅱ score and positively correlated with the GCS score. Conclusions： The early blood lactate clearance is correlated with the severe craniocerebral injury. Therefore,it can be used as an important indicator of prognosis of severe craniocerebral injury when combing with the APACHE Ⅱ score and GCS score.
出处
《中国民康医学》
2017年第15期96-97,113,共3页
Medical Journal of Chinese People’s Health
