摘要
目的:探讨高原地区危重患者术中乳酸水平与其术后病死率的相关性,为临床治疗提供参考。方法:回顾性分析100例需要进行手术的择期或急诊危重患者(ASA分级Ⅲ-Ⅳ级)为研究对象,根据患者术后疾病转归将其分为死亡组(n=24例)和存活组(n=76)两组,比较两组患者年龄、性别、急性生理学以及慢性健康状况评分(APACHEⅡ评分)、机械通气数量、机械通气时间、住ICU时间、乳酸、6 h乳酸清除率以及疾病构成的不同;观察不同乳酸水平、6 h乳酸清除率与患者病情和预后的关系;分析患者乳酸水平与预后相关参数的相关性。结果:死亡组患者在年龄、机械通气时间、机械通气数量、APACHEⅡ评分以及血乳酸含量明显高于存活组患者,血乳酸6 h乳酸清除率明显低于存活组患者(P<0.05);而在疾病构成方面,死亡组患者患有神经系统疾病以及心血管疾病的比例明显高于存活组(P<0.05);而两组患者患有消化系统疾病、呼吸系统疾病、复合伤以及其他疾病的比例无明显差异(P>0.05)。乳酸酸中毒组患者的住院天数、术后送ICU病例以及APACHEⅡ评分明显高于高乳酸血症组,6 h乳酸清除率明显低于高乳酸血症组患者(P<0.05);而两组不同血乳酸水平患者的病死率差异无统计学意义(P>0.05)。不同血乳酸清除率的两组患者的APACHEⅡ评分以及血乳酸水平差异无统计学意义(P>0.05);低清除率组患者的病死率为85.29%,明显高于高清除率患者的病死率(28.29%),差异有统计学意义(P<0.05)。患者的血乳酸水平与其机械通气天数呈现负相关(r=-0.358,P<0.01),与APACHEⅡ评分呈现正相关(r=0.305,P<0.01),而与患者的住ICU时间和病死率无关(r=0.865,P=0.087;r=0.968,P=0.106)。结论:高原地区危重患者的乳酸水平与其术后病死率无相关性,但与其病情危重程度呈正相关,而患者术中病死率与其血乳酸清除率密切相关。
Objective： To explore the correlation between lactic acid level and postoperative mortality in critically ill patients in plateau,and to provide reference for clinical treatment. Methods： A retrospective analysis of 100 patients with elective or emergency critically ill patients（ ASA grade Ⅲ-Ⅳ grade） was selected as the research object,the patients were divided into two groups： death group（ 24 cases） and survival group（ 76 cases）. The differences of age,sex,acute physiology and chronic health status scores（ APACHE Ⅱ score）,mechanical ventilation,mechanical ventilation time,ICU stay,lactic acid,lactic acid clearance 6 h and disease composition were compared between the two groups. To observe the relationship between lactic acid levels,6 h lactic acid clearance and patient disease and prognosis,and to analysis of patients with lactic acid levels and prognosis related parameters. Results： The age,duration of mechanical ventilation,number of mechanical ventilation,APACHE Ⅱ score and blood lactate content in death group were significantly higher than those of the survivors group,the lactic acid clearance rate of 6 h blood lactate was significantly lower than that of the survivors group（ P〈0. 05）,while in terms of the disease composition,death patients had significantly higher rates of neurological diseases and cardiovascular diseases（ P〈0. 05）. There was no significant difference in the proportion of patients with digestive diseases,respiratory diseases,combined injuries and other diseases between the two groups（ P〉0. 05）. Lactic acidosis patients in hospital stay,postoperative ICU cases and APACHE Ⅱ score was significantly higher than the group of hyperlactia,6 h lactic acid clearance was significantly lower than that of patients with hyperlactia,the difference was significant（ P〈0. 05）. There was no significant difference in mortality between two groups with different blood lactate levels（ P〉0. 05）. There was no statistical significance. There was no si
作者
吕志坚
LV Zhi-jian(Department of Anesthesiology,Affiliated Hospital of Qinghai University,Xining 810001,Qinghai,China)
出处
《川北医学院学报》
CAS
2018年第4期589-592,共4页
Journal of North Sichuan Medical College
基金
青海大学附属医院中青年科研项目(ASRF-2014-08)
青海省包虫病重点实验室项目
关键词
高原地区危重患者
乳酸水平
病死率
相关性
Plateau critically ill patients
Lactic acid level
Mortality
Correlation
