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目的探讨早期乳酸清除率对不同乳酸升高程度的严重脓毒症患者的预后评估价值。方法回顾性分析2007年5月～2010年5月入住我院综合ICU、存在严重脓毒症且乳酸高于2 mmol/L的279例患者的临床资料。147例患者纳入乳酸轻度升高人群(2～4 mmol/L),分为死亡和存活组,比较患者的一般资料、早期乳酸清除率、外科术后患者比例、急性生理与慢性健康评估Ⅱ(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分和其他反映全身脏器或系统功能的临床指标,进行死亡危险因素分析;再以10%的乳酸清除率为界,将此人群患者分为高、低清除率组,进行Kaplan-Meier生存分析。其余132例患者纳入乳酸明显升高人群(≥4 mmol/L),同上方法进行死亡危险因素分析及Kaplan-Meier生存分析。结果乳酸轻度升高人群死亡危险因素为APACHEⅡ评分和血糖,其OR及95%CI为1.204(1.120-1.294)、1.131(1.001-1.280),高、低清除率组患者30 d病死率的差异无统计学意义(29.03%vs 31.76%,P>0.05)。乳酸明显升高人群的死亡危险因素为早期乳酸清除率、APACHEⅡ评分、是否外科术后和氧合指数,其OR值及95%CI分别为0.953(0.920-0.987)、1.222(1.097-1.361)、0.078(0.016-0.382)、0.989(0.982-0.997),低清除率组患者的30 d病死率明显升高(97.92%vs 65.84%,P<0.001)。结论早期乳酸清除率能有效评价乳酸明显升高的严重脓毒症患者的预后,但对于乳酸轻度升高的患者,其预后提示价值不佳。
Objective To investigate the prognostic value of early lactic acid clearance in patients with severe sepsis with different levels of lactic acid. Methods The clinical data of 279 patients with severe sepsis who had lactic acid above 2 mmol / L admitted to our hospital from May 2007 to May 2010 were retrospectively analyzed. One hundred and forty-seven patients were enrolled in the group of mildly elevated lactate (2-4 mmol / L) and divided into death and survival groups. Comparisons of general data, early lactic acid clearance, postoperative surgical patient ratio, acute physiology and chronic health assessment II (APACHE II) score, sequential organ failure (SOFA) score and other clinical indicators that reflect the function of the whole organ or system were analyzed. Risk factors of death were analyzed. With 10% lactic acid clearance rate, the patients were divided into high , Low-clearance group, Kaplan-Meier survival analysis. The remaining 132 patients were enrolled in a significantly elevated population of lactate (≥4 mmol / L), followed by analysis of risk factors for death and Kaplan-Meier survival analysis. Results The APACHE Ⅱ score and blood sugar were significantly higher in patients with mildly elevated lactate. The OR and 95% CI were 1.204 (1.120-1.294) and 1.131 (1.001-1.280), respectively. The difference in 30-day mortality between patients with high and low clearance rate No statistical significance (29.03% vs 31.76%, P> 0.05). The risk factors of mortality in patients with elevated lactate were early lactate clearance rate, APACHEⅡscore, whether postoperative and oxygenation index, OR and 95% CI were 0.953 (0.920-0.987), 1.222 (1.097-1.361), 0.078 (0.016-0.382), 0.989 (0.982-0.997). The 30-day mortality rate was significantly higher in patients with low clearance rate (97.92% vs 65.84%, P <0.001). Conclusions Early lactic acid clearance can effectively evaluate the prognosis of patients with severe sepsis with significantly elevated lactate, but its prognosis is poor for patients with mild increase in lactate.