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目的:分析动态监测血乳酸(LAC)、C反应蛋白(CRP)及中心静脉血氧饱和度(ScvO_2)水平对评估脓毒症预后的价值。方法:选择我院收治的脓毒症60例,根据结局分为存活组36例和死亡组24例。分别于入院时及入院后6h、12h、24h、48h、72h,抽取桡动脉血采用血气分析仪测定LAC、抽取肘静脉血采用免疫比浊法测定CRP及中心静脉导管抽取中心静脉血测定ScvO_2水平。观察两组上述指标的动态变化情况并比较其差异。结果:存活组LAC水平在入院48h基本恢复至正常水平;死亡组入院后72h仍高于正常值,入院后第6h、12h、24h、48h、72hLAC水平均显著高于存活组(P<0.05)。两组CRP水平均于入院后48h达高峰,存活组在入院后72h显著下降(P<0.05),死亡组无显著下降(P>0.05)。存活组入院后第48h、72hCRP水平显著高于存活组(P<0.05)。入院后存活组ScvO_2水平逐渐上升,死亡组呈逐渐降低趋势;死亡组入院后6h、12h、24h、48h、72hScvO_2水平均显著低于存活组(P<0.05)。结论:早期动态监测LAC、CRP及ScvO_2水平,对评估脓毒症病情严重程度及预后有较好的参考价值。
Objective: To analyze the value of dynamic monitoring of blood lactic acid (LAC), C-reactive protein (CRP) and central venous oxygen saturation (ScvO_2) in evaluating the prognosis of sepsis. Methods: Seventy patients with sepsis admitted to our hospital were divided into 36 survivors and 24 deaths according to the outcome. At the time of admission and after admission, 6h, 12h, 24h, 48h, 72h, radial artery blood samples were taken for the determination of LAC by blood gas analyzer and elbow vein extraction. CRP and central venous catheter were collected for central venous blood by immunoturbidimetric assay for determination of ScvO_2 . Observe the dynamic changes of the above two indexes and compare their differences. Results: The levels of LAC in survivors returned to normal levels 48h after admission. The levels of LAC in death groups were still significantly higher than normal at 72h after admission, and the levels of LAC at 6h, 12h, 24h, 48h, 72h after admission were significantly higher than those in survivors (P <0.05) . The CRP levels in both groups peaked at 48h after admission, and the survival group decreased significantly at 72h after admission (P <0.05), but there was no significant decrease in death group (P> 0.05). The levels of CRP in survivors at 48h and 72h after admission were significantly higher than those in survivors (P <0.05). After admission, the level of ScvO_2 gradually increased in the survivors, and gradually decreased in the death group. The levels of ScvO_2 in the death group at 6h, 12h, 24h, 48h and 72h after admission were significantly lower than those in the survivors (P <0.05). Conclusion: The early dynamic monitoring of LAC, CRP and ScvO_2 levels is of great value in assessing the severity and prognosis of sepsis.