摘要
目的评价动态监测血乳酸及乳酸清除率与重症医学科(ICU)休克患者预后的关系。方法收集2008年9月-2010年6月收住ICU的成年休克患者共58例。对纳入患者均经过积极的病因治疗和对症、支持治疗,测定患者入ICU时(0h)、入ICU后6h、24h、48h血乳酸值,以后每24h测定一次,直到血乳酸降至正常范围内或出院或死亡;计算6h、24h的乳酸清除率,分析血乳酸水平、乳酸清除率与患者预后的关系。结果共42例休克患者纳入本研究,其中感染性休克25例,低血容量性休克17例,男性25例,女性17例,平均年龄(53.92±17.59)岁;平均APACHEⅡ评分20±4,血乳酸(9.04±2.55)mmol/L;死亡组入住0h、6h、24h的血乳酸水平明显高于存活组;存活组6h和24h乳酸清除率明显高于死亡组(P<0.01,P<0.05),而两组高乳酸持续时间无明显差别。结论动态监测血乳酸对于休克患者具有重要意义,6h、24h乳酸清除率可作为判断预后的指标之一。
Objective To evaluate the value of dynamic blood laetate level and lactate clearance rate in the prognosis judgment of patients with shock in intensive care unit（ICU）. Methods .Fifty-eight adult shock patients from Sep. 2008 to Jan. 2010 were included in this study. All eligible patients received the etilogical treatment, symptomatic treatment and supporting therapy, The level of the lactate at 0 h,6 h,24 h,48 h（then each 24 h） were detected after admission in ICU,and the lactate clearance rate at 24 h and 48 h were calculated. The relation between lactate level,lactate clearance rate and the prognosis judgment of patients were evaluated. Results In all 42 shock patients,there were 25 septic shock and 17 hypovulemic shock;there were 25 male and 17 female cases ,their mean age was （53.92 ± 17.59） years. The average APACHE II score at 0 h was 20 ±4,and the average concentration of lactate in blood was （9.04 ±2.55 ） mmol/L. The concentration of lactate at 0 h,6 h and 24 h in survival group were significantly lower than the death group,while the lactate clearance rate at 6 h and 24 h in the survival group were significantly higher than that in the death group. There was no significant difference in the duration of high lacticemia between two groups. Conclusion Dynamic observation of lactate level is very important for the shock patients. The 6 h and 24 h lactate clearance rate may be an important indicator in predicting the prognosis of .patients with shock.
出处
《中华全科医学》
2010年第12期1535-1536,共2页
Chinese Journal of General Practice
关键词
乳酸
乳酸清除率
重症医学科
休克
预后
Lactic acid
Lactic clearance
Intensive care unit
Shock
Prognosis
