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目的探讨重型颅脑损伤患者早期乳酸清除率与预后的关系。方法重型颅脑损伤患者198例,测定入院时及治疗后12h动脉血乳酸,计算12h乳酸清除率。以12h乳酸清除率为界限分为高乳酸清除率(≥10%,A组,131例)组和低乳酸清除率(<10%,B组,67例)组,比较两组多脏器功能衰竭(MOFS)及病死率的差异。结果两组治疗前格拉斯哥昏迷评分和急性生理学和慢性健康状况评分系统Ⅱ评分均无统计学差异(P>0.05)。A组MOFS发生率低于B组(30.54%vs.73.13%)(P<0.01);A组病死率低于B组(22.90%vs.68.66%)(P<0.01)。结论约35%的重型颅脑外伤患者入院时处于高乳酸血症状态;12h乳酸清除率可作为评估重型颅脑损伤患者病情严重程度及预后的指标。
Objective To investigate the relationship between early lactic acid clearance and prognosis in patients with severe craniocerebral injury. Methods 198 cases of severe craniocerebral injury patients, determination of arterial blood lactate at admission and 12h after treatment, calculation of lactic acid clearance 12h. 12 h lactic acid clearance rate was divided into high lactate clearance (≥10%, A group, 131 cases) and low lactic acid clearance (<10%, B group, 67 cases) group, compared two groups of multiple organ function Failure (MOFS) and mortality differences. Results There was no significant difference in Glasgow Coma Scale and Acute Physiology and Chronic Health Score II before treatment in both groups (P> 0.05). The incidence of MOFS in group A was lower than that in group B (30.54% vs.73.13%) (P <0.01). The mortality in group A was lower than that in group B (22.90% vs.68.66%) (P <0.01). Conclusions About 35% of patients with severe traumatic brain injury are in the state of hyperlactic acid at admission. The lactic acid clearance at 12 hours can be used as an index to assess the severity and prognosis of patients with severe craniocerebral injury.