摘要
目的探究在ICU危重症伴休克患者诊疗中应用血乳酸监测的临床效果。方法选取2019年1月至2020年5月本院ICU收治的危重症伴休克患者64例作为研究对象,给予患者常规救治,并动态监测血乳酸水平,根据预后情况分为存活组(n=50)和死亡组(n=14),比较两组患者乳酸指标。根据6 h乳酸清除率分为高清除率组(>10%,n=42)和低清除率组(≤10%,n=22),比较两组多脏器功能障碍、病死情况以及APACHEⅡ评分;根据血乳酸峰值分为高乳酸血症组(<4 mmol/L,n=20)、轻度乳酸中毒组(血乳酸峰值于4~10 mmol/L,n=29)和重度乳酸中毒组(>10 mmol/L,n=15),比较3组多脏器功能障碍、病死情况以及APACHEⅡ评分。结果死亡组患者血乳酸值、乳酸峰值均明显高于存活组,差异有统计学意义(P<0.05);死亡组6 h和24 h乳酸清除率明显低于存活组,差异有统计学意义(P<0.05);低清除率组APACHEⅡ评分、脏器功能障碍发生率和病死率明显高于高清除率组,差异有统计学意义(P<0.05);高乳酸血症组、轻度中毒组和重度中毒组APACHEⅡ评分、多脏器功能障碍发生率、病死率比较差异均有统计学意义(P<0.05)。结论在ICU危重症伴休克患者诊疗中监测血乳酸利于患者预后,血乳酸水平与休克的严重程度密切相关,是一种疾病早期预警的可靠指标,对指导患者接受后续治疗措施,评估预后效果具有积极意义,值得临床推广运用。
Objective To explore the clinical effect of blood lactic acid monitoring in ICU patients with critical illness and shock.Methods A total of 64 patients with severe shock admitted to the ICU of our hospital from January 2019 to May 2020 were selected as the research subjects.Routine treatment was given to the patients,and blood lactate level was dynamically monitored.According to the prognosis,the patients were divided into the survival group(n=50)and the death group(n=14),and the lactate indexes between the two groups were compared.According to 6 h lactate clearance rate they were divided into high clearance group(>10%,n=42)and low clearance group(≤10%,n=22),compared two groups of multiple organ dysfunction,and death and APACHEⅡscore;according to the peak of blood lactic acid they were divided into high lactic acidosis group(<4 mmol/L,n=20),mild levels of lactic acid poisoning group(4-10 mmol/L,n=29)and high levels of lactic acid poisoning group(>10 mmol/L,n=15),compared three groups of multiple organ dysfunction,death rate and APACHEⅡscore.Results Blood lactic acid value and peak value in the death group were significantly higher than those in the survival group,the difference was statistically significant(P<0.05).The lactate clearance rate at 6 h and 24 h in the death group were significantly lower than that in the survival group,the difference was statistically significant(P<0.05).APACHEⅡscore,viscera dysfunction incidence and case fatality rate in low clearance group were significantly higher than high clearance group,the difference was statistically significant(P<0.05).There was statistically significant difference in APACHEⅡscore,incidence of multiple organ dysfunction and mortality in hyperlactic acid group,mild intoxication group and severe intoxication group(P<0.05).Conclusion Monitoring blood lactic acid in ICU critical patients with shock is beneficial to the prognosis of patients.Blood lactic acid level is closely related to the severity of shock,and it is a reliable indicator for early warning of disease.It has positive significance for guiding patients to receive follow-up treatment measures and evaluating the prognosis effect,and is worthy of clinical promotion and application.
作者
张林浩
ZHANG Linhao(Shanxi Cancer Hospital,Taiyuan,Shanxi,030013,China)
出处
《当代医学》
2021年第13期35-37,共3页
Contemporary Medicine
关键词
血乳酸监测
ICU
危重症
休克
诊疗效果
Blood lactate monitoring
ICU
Critical illness
Shock
Diagnosis and treatment effect
