摘要
目的探讨严重脓毒症患者集束化治疗后6 h内早期乳酸正常化和24 h内延迟乳酸正常化对28 d预后的影响。方法选择2013年1月至2019年11月海南医学院第二附属医院收治的严重脓毒症患者的临床资料进行回顾性分析。根据集束化治疗后28 d预后分为存活组和死亡组,比较2组患者一般资料、临床特征、集束化治疗后6 h与24 h乳酸正常化比例。同时比较6、24 h乳酸正常化与6、24 h乳酸非正常化患者28 d病死率。采用多因素Logistic回归方法分析严重脓毒症患者28 d死亡的危险因素。结果本研究共纳入1 997例严重脓毒症患者,其中28 d随访时426例(21.3%)患者死亡(死亡组),1 571例(78.7%)患者存活(存活组)。死亡组患者集束化治疗6、24 h乳酸正常化比例明显低于存活组(均P <0.05)。774例患者6 h乳酸正常化,1 223例患者6 h乳酸非正常化,28 d病死率分别为12.7%(98例)与26.8%(328例),差异有统计学意义(P <0.001);1 095例患者24 h乳酸正常化,902例患者24 h乳酸非正常化,28 d病死率分别为12.5%(137例)与32.0%(289例),差异有统计学意义(P <0.001)。多因素Logistic回归分析显示,经调整传统危险因素后,6、24 h乳酸正常化均为严重脓毒症患者28 d预后的独立保护因素(均P <0.001)。结论集束化治疗后6 h内早期乳酸正常化和24 h内延迟乳酸正常化均为严重脓毒症患者28 d预后的独立保护因素,乳酸正常化可能在早期危险分层中起重要作用,也可能是治疗的目标。
Objective To explore the effect of early lactate normalization within 6 h and late lactate normalization within 24 h on 28 d prognosis in patients with severe sepsis after cluster therapy.Methods The clinical data of patients with severe sepsis admitted to the Second Affiliated Hospital of Hainan Medical University from January 2013 to November 2019 were retrospectively analyzed.The patients were divided into survival group and death group according to the 28 d prognosis after cluster therapy.The differences of general condition,clinical features,the rates of lactate normalization within 6 h and 24 h after cluster therapy were compared between the two groups.The 28 d mortality of the patients having lactate normalization within 6 h and 24 h was compared with that of the patients without achieving lactate normalization within 6 h and 24 h.The independent risk factors of the 28 d dead in patients with severe sepsis were analyzed by multivariate Logistic regression.Results A total of 1997 patients with severe sepsis were enrolled;426(21.3%)patients died(death group),and 1571(78.7%)survived(survival group).In the death group,the rates of lactate normalization within 6 h and 24 h were significantly lower than those in the survival group,with statistically significant differences(all P<0.05).There were 774 patients achieving lactate normalization within 6 h;1223 patients did not achieve lactate normalization within 6 h;the 28 d mortality was 12.7%(98 cases)and 26.8%(328 cases)respectively with statistically significant differences(P<0.001).There were 1095 patients achieving lactate normalization within 24 h;902 patients did not achieve lactate normalization within 24 h;the 28 d mortality was 12.5%(137 cases)and 32.0%(289 cases)respectively with statistically significant differences(P<0.001).Multivariate Logistic regression analysis showed that lactate normalization within 6 h and 24 h was independent protective factors for 28 d dead in patients with severe sepsis(both P<0.001).Conclusions Early lactate normalization wi
作者
王明禄
邢柏
Wang Minglu;Xing Bo(Department of Emergency,Donghu Branch of the Second Affiliated Hospital of Hainan Medical Univercity,Haikou 570311,China)
出处
《中国医药》
2020年第10期1594-1598,共5页
China Medicine
基金
海南省自然科学基金(819MS128)。
关键词
严重脓毒症
集束化治疗
乳酸正常化
预后
Severe sepsis
Cluster therapy
Lactate normalization
Prognosis
