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目的:研究乳酸和急性生理学及慢性健康状况评分(APACHE Ⅱ评分)对老年脓毒症患者预后的评估作用。方法:老年脓毒症患者96例,按照入院时血乳酸值分成升高者60例,乳酸正常者36例,比较两组的病死率、休克、机械通气和MODS发生率、APACHE Ⅱ评分的区别;根据APACHE Ⅱ评分(<15、15～24、≥25)分为3组,比较每组患者的病情和预后区别。结果:乳酸升高组老年脓毒症患者的机械通气、休克发生率、MODS发生率、APACHE Ⅱ评分明显大于乳酸正常组(P<0.05),病死率明显上升(28.3%vs 2.7%),(P=0.005);随着APACHE Ⅱ评分增高,患者病情逐渐加重,休克发生率和住院病死率明显升高,(P<0.05),患者乳酸水平也明显增高(P<0.05)。结论:血乳酸和APACHE Ⅱ评分都可以评估老年脓毒症患者病情严重和预后,两者升高提示预后差。
Objective: To evaluate the effect of lactic acid, acute physiology and chronic health assessment (APACHE Ⅱ) on the prognosis of elderly patients with sepsis. Methods: A total of 96 elderly patients with sepsis were enrolled in this study. According to the differences in the incidences of death, shock, mechanical ventilation, MODS and APACHE Ⅱ scores between the two groups, According to APACHE Ⅱ score (<15,15 ~ 24, ≥25), the patients were divided into three groups, and the differences of the disease and prognosis of each group were compared. Results: The mechanical ventilation, the incidence of shock, the incidence of MODS, the APACHE Ⅱ score in elderly patients with lactic acidosis were significantly higher than those in normal lactic acid group (P <0.05), the mortality was significantly increased (28.3% vs 2.7%), P = 0.005). With the increase of APACHE Ⅱ score, the patient’s condition gradually aggravated, the incidence of shock and in-hospital mortality significantly increased (P <0.05), and the level of lactic acid in patients also increased significantly (P <0.05). Conclusion: The blood lactate and APACHE Ⅱ scores can assess the seriousness and prognosis of elderly patients with sepsis, both of which suggest that the prognosis is poor.