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目的探讨动态监测血乳酸对感染性休克患者治疗和预后的评价作用。方法对32例感染性休克患者,按早期目标指导治疗(EGDT)开始前(0h)测得的动脉血乳酸值,分为A组(<2mmol/L,8例)、B组(2-4mmol/L,11例)和C组(≥4mmol/L,13例)。测定EGDT开始后2、6、12、24及48h血乳酸,比较各组血乳酸和乳酸清除率的变化及APACHEⅡ评分情况。结果与EGDT开始前血乳酸比较,A组血乳酸无明显下降,B组24及48h明显下降(P<0.05),C组在12、24及48h均有明显下降(P<0.05)。与A组比较,B组、C组6h乳酸清除率均明显下降,病死率升高(P<0.05)。各组APACHEⅡ评分在EGDT开始后都呈进行性下降,C组APACHEⅡ分值均高于A、B组。结论血乳酸动态监测对感染性休克患者具有早期评估治疗及预后的作用;EGDT开始前血乳酸越高则预后越差。
Objective To evaluate the effect of dynamic monitoring of blood lactate on the treatment and prognosis of septic shock patients. Methods 32 patients with septic shock were divided into group A (2 mmol / L, 8 cases), group B (2-4 mmol) / L, 11 cases) and C group (≥4mmol / L, 13 cases). The blood lactic acid was measured at 2, 6, 12, 24 and 48 hours after the onset of EGDT. The changes of blood lactic acid and lactic acid clearance and APACHE II score were compared between the two groups. Results Compared with the blood lactate before EGDT, the blood lactic acid in group A was not significantly decreased (P <0.05), but decreased in group B at 24, 48 and 48 h (P <0.05). Compared with group A, the lactic acid clearance rate of group B and group C decreased significantly at 6 hours, and the mortality rate increased (P <0.05). The APACHEⅡscores of all the groups decreased progressively after the start of EGDT, and the scores of APACHEⅡof C group were higher than those of A and B groups. Conclusion The dynamic monitoring of blood lactate has an early evaluation of the treatment and prognosis of patients with septic shock. The higher the blood lactate before EGDT, the poorer the prognosis.