摘要
目的 探讨早期检测动脉血乳酸对脓毒症患者预后的评估价值.方法 回顾性分析2009-07-2011-12入住我院ICU脓毒症患者的临床资料,按照预后（死亡和存活）及感染程度（脓毒症、严重脓毒症和感染性休克）分组,分别比较各组动脉血乳酸及其与降钙素原和APACHEⅡ评分的相关性,观察其预测预后的ROC曲线下面积,并确定其预测脓毒症预后的最佳截断值.结果 共计纳入114例,其中男性80例,女性34例.按照预后及感染程度分组比较动脉血乳酸浓度,各组比较差异均有统计学意义（P〈0.05）.动脉血乳酸浓度与降钙素原及APACHEⅡ评分均具有良好的相关性.动脉血乳酸预测脓毒症预后的曲线下面积为77.4%,乳酸联合降钙素原的曲线下面积为80.3%.乳酸为2.0 mmol/L具有较高的敏感性及阳性似然比.结论动脉血乳酸可以较好地预测脓毒症患者预后.
Objective To study the prognostic value of arterial blood lactate for sepsis patients. Methods Clinical data about patients were collected and recorded in our ICU from July 2009 to December 2011. We included cases according to the predefined inclusion and exclusion criteria. We compared arterial blood lactate concentrations according to the classification of different outcomes （survivors and nonsurvivors） and sepsis （sepsis, severe sepsis and septic shock）. The correlation of arterial blood lactate concentration with procalcitonin （PCT） or acute physiology and chronic health evaluation II scores （APACHE I1 ） was also analyzed. The receiver operating characteristic curve （ROC） was drawn and the measure of area below the ROC curve was calculated to see its function in judging the prognosis of sepsis. At last, we tried to find the best cut - off value of arterial blood lactate to the prognosis of sepsis. Results 114 cases were included, among which 80 cases were male and the other 34 cases were female. According to classification of different outcomes and sepsis, arterial blood lactate concentrations in different groups had significant differences （ P 〈 0.05 ）. PCT levels or APACHE ]I scores were associated with arterial blood lactate concentrations significantly. The ROC in predicting mortality was 77.4% for arterial blood lactate and 80. 3% for the merger of arterial blood lactate and PCT. Using arterial blood lactate 2 mmol/L as a cut - off value had a better sensitivity and positive predictive value（PPV）. Conclusion Arterial blood lactate can be a better evaluation of septic patients prognosis.
出处
《中国急救医学》
CAS
CSCD
北大核心
2013年第7期596-600,共5页
Chinese Journal of Critical Care Medicine
