ICU危重患者血乳酸变化水平与预后的关系探讨

林书生; 高勃; 姜平; 张炜

doi:10.13201/j.issn.1009-5918.2013.01.017

ICU危重患者血乳酸变化水平与预后的关系探讨

- 淮安市肿瘤医院ICU(江苏淮安,223200)

详细信息

通讯作者: 林书生,E-mail:jshalss@sohu.com

中图分类号: R459.7

收稿日期: 2012-06-07

The study of relationship between the change of blood lactate level and prognosis of critically ill patients in intensive care unit

- Intensive Care Unit Department, Tumor Hospital of Huai'an City, Huai'an, Jiangsu, 223200, China

More Information

Corresponding author: LIN Shusheng, E-mail: jshalss@sohu.com

Received Date: 07 June 2012

摘要

摘要: 目的:探讨重症监护病房(ICU)内血乳酸增高的危重病患者的乳酸水平变化情况与7d、28d预后的关系。方法:收集ICU内动脉血乳酸水平升高的患者共133例,比较7d、28d的病死率。按7d、28d存活或死亡情况分组观察一般资料、乳酸指标(入ICU乳酸高值,8h、24h乳酸清除率)、住ICU天数、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分。分别按入院乳酸高值分组、按8h、24h乳酸清除率分组、按高乳酸时间分组比较各组患者的一般资料、APACHEⅡ评分、7d和28d病死率。结果:住ICU乳酸升高患者28d病死率较7d病死率明显升高(P<0.01)。7d、28d死亡组患者乳酸值、APACHEⅡ评分均显著高于生存组(P<0.05、0.01),乳酸8h清除率、24h清除率均显著低于生存组(P<0.01)。严重乳酸酸中毒组7d病死率、A-PACHEⅡ评分明显高于高乳酸血症组(P<0.01、0.05),28d病死率无明显差异;而高乳酸血症组与乳酸酸中毒组之间观察值均无明显差异。各高清除率组与低清除率组比较,7d、28d病死率均明显降低(P<0.01),各中、低清除率组之间比较仅24h低清除率组28d病死率较中清除率组明显升高(P<0.01),其余各观察值均无明显差异。高乳酸时间>8h组、>24h组7d、28d病死率均较<8h组明显升高(P<0.01),且28d病死率较7d病死率组明显升高(P<0.05)。结论:ICU病房内血乳酸水平增高的危重病患者28d的总体病死率比7d病死率明显增加。入院血乳酸水平、乳酸清除率、高乳酸时间均是评估患者预后的良好指标,而且随着高乳酸时间的延长,28d病死率比7d病死率明显增高,在8h内将血乳酸降至正常范围内可能改善危重患者的预后。
- 乳酸 /
- 乳酸清除率 /
- 高乳酸时间 /
- 预后
Abstract: Objective:To study the relationship between the change of blood lactate level and the prognosis of critically ill patients in intensive care unit(ICU).Method:One hundred and thirty-three cases of patients with elevated arterial blood lactate levels in ICU were collected in our study.The mortality of 7 d and 28 d was analyzed.All the patients were grouped according to the survival of 7 d,28 d,and the general information,lactate index(peak lactate level in ICU,8 h,24 h lactate clearance rate),the days that stay in ICU,acute physiology and chronic health evaluation score Ⅱ(APACHE Ⅱ) were recorded and compared.The patients were grouped according to peak lactate level,and the lactate clearance rate at 8 h or 24 h,the duration of high lactate,the differences in their general information,APACHE Ⅱ score,mortality at 7 d and 28 d were compared.Result:The mortality of patients with lactate increase in ICU was significantly higher in 28d than in 7 d(33.08% vs 18.05%,P<0.01).The peak lactate level,APACHE Ⅱ of 7 d,28 d in death group were significantly higher than that of survival group(P<0.05,0.01).The 8 h,24 h lactate clearance rate of the death group were significantly lower than that of survival group(P<0.01).The 7 d mortality,APACHE Ⅱ score of the severe lactic acidosis group were significantly higher than that of high lactate group(P<0.01,0.05).But the 28 d mortality has no significant difference.There were no statistically differences in 7 d and 28 d mortality,APACHE Ⅱ score between the high lactate group and the lactic acidosis group.The 7 d and 28 d mortality of the high lactate clearance rate group were significantly lower than that of the low clearance rate group(P<0.01).The 28 d mortality of the 24 h low clearance rate group was significantly higher than that of the 24 h secondary clearance rate group(P<0.01).The 7 d,28 d mortality of high lactate> 8 h group and >24 h group were significantly higher than of the <8 h group(P<0.01),and the 28 d mortality was significantly higher than 7 d mortality(P<0.05).Conclusion:The overall mortality of 28 d of patients with lactate increase in ICU was significantly high than 7 d.The peak lactate level,lactate clearance rate,high lactate time are good indicators to evaluate patients' prognosis.With the extension of the high lactate time,28 d mortality was significantly higher than 7 d-mortality,blood lactate level fell within normal limits in 8 h may improve the prognosis of critically ill patients.
- lactate /
- lactate clearance rate /
- duration of hyperlactatemia /
- prognosis

HTML全文

参考文献(13)

[1]	李海玲,任红贤,林慧艳,等.危重患者血乳酸水平与院内病死率的相关性研究[J].实用医学杂志,2011,28(5):385-389.
[2]	KHOSRAVANI H,SHAHPORI R,STELFOX H T,et al.Occurrence and adverse effect on outcome of hy-perlactatemia in the critically ill[J].Crit Care,2009,13:90-94.
[3]	BAKKER J,GRIS P,COFFERNILS M,et al.Serial blood lactate levels can predict the development of multiple organ failure following sepsis shock[J].Am J Surg,1996,171:221-226.
[4]	CUSACK R J,RHOLDES A,LOCHHEAD P,et al.The strong ion gap does not have prognostic value in critically ill patients in a mixed medical/surgical adultICU[J].Intensive Care Med,2002,28:864-869.
[5]	NICHOL A D,EGL M,PETTILA V,et al.Relative hyperlactatemia and hospital mortality in critically ill patients:a retrospective multicentre study[J].Crit Care,2010,14:25-33.
[6]	王昊,吴大玮,陈晓梅,等.血乳酸水平及清除率和升高时间与重症监护病房危重患者预后的关系[J].中国危重病急救医学,2009,21(6):357-360.
[7]	蒋文中,汤彦.危重病乳酸增高机制及其在预后中价值[J].临床荟萃,2004,9(7):405-407.
[8]	NGUYEN H B,RIVERS E P.Early lactate clearance is associated with improved outcome in severe sepsis and septic shock[J].Care Med,2004,32:1637-1642.
[9]	杨从山,邱海波,黄英姿,等.动态监测动脉血乳酸水平对感染性休克患者预后评估价值的前瞻性研究[J].中华外科杂志,2009,47:685-688.
[10]	田焕焕,韩沙沙,吕长俊,等.早期目标清除率对肺部感染致脓毒性休克治疗的作用[J].中国危重病急救杂志,2012,24(1):42-45.
[11]	ABRAMSON D,SCALEA T M,HITCHCOCK R,et al.Lactate clearance and survival following injury[J].J Trauma,1993,35:584-589.
[12]	MCNELIS J,MARINI C P,JURKIEWICZ A,et al.Prolonged lactate clearance is associated with in-creased mortality in the surgical intensive care unit[J].Am J Surg,2001,182:481-485.
[13]	VINCENT J L,DUFAYE P,BERRE J.Serial lactate determinations during circulatory shock[J].Crit Care Med,1983,11:449-451.