摘要
目的探讨重症医学科(ICU)中非心脏和心脏手术术后血乳酸水平在评估患者预后中的价值。方法回顾性分析2016年5月至2018年5月该院ICU收治的488例非心脏和心脏手术术后患者的临床资料。依据患者住院期间的血乳酸平均值将以上两组患者再分为高血乳酸组(≥4mmol/L)、中高血乳酸组(2~<4mmol/L)和正常血乳酸组(0~<2mmol/L),统计分析血乳酸平均值和患者预后的相关性。同时根据血乳酸变异度的四分位数将上述两组患者再分为4组,运用多因素回归分析不同血乳酸变异度水平患者的死亡风险。依据患者转入ICU后的血乳酸首值、首个24h血乳酸峰值绘制受试者工作特征(ROC)曲线,评估以上两个指标在预测患者预后中的价值。结果488例ICU收治的非心脏和心脏手术术后患者分别为237例和251例,两组患者的一般资料差异无统计学意义(P>0.05),具有可比性。在高血乳酸水平(≥4mmol/L)时,非心脏术后组和心脏术后组患者病死率分别为60.00%、32.79%,两组比较差异有统计学意义(P<0.01)。非心脏术后组患者血乳酸变异度与病死率呈线性关系,与血乳酸变异度小于0.52mmol·L^-1·d^-1组比较,血乳酸变异度为0.52~<0.87mmol·L^-1·d^-1组(OR=1.17,P=0.84)患者病死率差异无统计学意义,但0.87~<1.48mmol·L^-1·d^-1组(OR=4.75,P=0.02)、≥1.48mmol·L^-1·d^-1组(OR=21.81,P<0.01)患者病死率差异有统计学意义。而心脏术后组患者死亡风险随着血乳酸变异度的升高而逐渐升高,与血乳酸变异度小于0.58mmol·L^-1·d^-1组比较,0.58~<1.32mmol·L^-1·d^-1组(OR=1.17,P=0.82)、1.32~<2.41mmol·L^-1·d^-1组(OR=2.84,P=0.08)患者病死率差异无统计学意义;≥2.41mmol·L^-1·d^-1组(OR=15.80,P<0.01)患者病死率差异有统计学意义。ROC曲线分析显示两组患者入住ICU首个24h血乳酸峰值ROC曲线下面积(AUC)均高于血乳酸首值,提示入住ICU首个24h血乳酸峰值评估预后的敏感度及特异度高于乳
Objective To investigate the value of non-cardiac and cardiac postoperative serum lactic acid levels in evaluating the prognosis of patients.Methods The clinical data of 488 non-cardiac(non-cardiac postoperative group)and cardiac(cardiac postoperative group)postoperative patients admitted to ICU of this hospital from May 2016 to May 2018 were retrospectively analyzed.According to the average value of serum lactic acid during hospitalization,the two groups of patients above were subdivided into high serum lactic acid group(≥4 mmol/L),medium high serum lactic acid group(2-<4 mmol/L)and normal serum lactic acid group(0-<2 mmol/L)according to the mean value of lactic acid during hospitalization.At the same time,the two groups were divided into 4 groups according to the quartile of the degree of lactic acid variability,and the risk of death of different levels of lactic acid variability was analyzed by multivariate regression.The receiver operating characteristic(ROC)curve was drawn based on the first serum lactic acid value after patients were transferred in to ICU and the first 24 h serum lactic acid peak value,and the value of the above two indicators in predicting the prognosis of patients was evaluated.Results There were 237 patients and 251 patients in non-cardiac post-operative and cardiac post-operative group respectively in this study,and the general datas of the two groups were not significantly different and comparable.In the high blood lactate level group,the mortality rates of non-cardiac postoperative group and cardiac postoperative group were 60.00%and 32.79%respectively,and there was significant statistical difference between the two groups(P<0.01).There was a linear relationship between lactic acid variability and mortality in non-cardiac postoperative group.Compared with the<0.52 mmol·L^-1·d^-1 group of serum lactic acid variability,the mortality of the 0.52-<0.87 mmol·L^-1·d^-1 group(OR=1.17,P=0.84)had no significant difference,but the 0.87-<1.48 mmol·L^-1·d^-1 group(OR=4.75,P=0.02)and≥1.4
作者
李骏
喻莉
武晓灵
卜晓芬
LI Jun;YU Li;WU Xiaoling;BU Xiaofen(Department of Critical Care Medicine,Affiliated Wuhan Central Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430014,China;Second General Department,Affiliated Wuhan Central Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430014,China)
出处
《重庆医学》
CAS
2019年第16期2767-2771,共5页
Chongqing medicine
基金
湖北省武汉市卫生和计划生育委员会面上重点项目(WX18A02)
关键词
乳酸
非心脏外科手术
心脏外科手术
预后
lactic acid
non-cardiac surgical procedures
cardiac surgical procedures
prognosis
