严重高乳酸血症患者的临床特征及预后分析

钱际银; 张云; 邓淑坤; 袁丽

doi:10.13201/j.issn.1009-5918.2021.06.004

严重高乳酸血症患者的临床特征及预后分析

- 南京医科大学附属无锡人民医院急诊科(江苏无锡,214023)
基金项目:
南京医科大学科技发展基金(一般项目)(No:NMUB2018358)

详细信息

通讯作者: 张云,E-mail:43017521@qq.com

中图分类号: R589

收稿日期: 2021-03-04

Clinical characteristics and prognostic in patients with severehyperlactatemia

- Department of Emergency Medicine, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, 214023, China

More Information

Corresponding author: ZHANG Yun, E-mail: 43017521@qq.com

Received Date: 04 March 2021

摘要

摘要: 目的:探讨严重高乳酸血症(动脉血乳酸>5 mmol/L)患者的临床特征及预后分析。方法:采取回顾性研究方法,收集2016年12月-2019年5月期间我院急诊科收治的入院48 h内动脉血乳酸>5 mmol/L的患者一般资料,分析其临床特征。根据患者入院第28天存活情况分为存活组和死亡组。收集患者入院当天的生命体征、每小时尿量、平均动脉血压、血常规、血生化组合、凝血功能、心肌酶谱、心梗二项、动脉血气分析等,根据患者当日最差数据计算序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分系统(APACHEⅡ)、格拉斯昏迷指数评分(GCS),根据ROC曲线评估影响预后的危险因素。结果:179例中剔除入院后2 h内放弃治疗及资料丢失的患者21例,共纳入患者158例。其中男100例(63.3%),女58例(36.7%)。在监护病房的患者有69例(43.6%)。普通病房患者共89例(56.4%)。患者主诊断为脓毒症、心肺复苏后、热射病、中毒、急性心肌梗死等。28 d存活100例,死亡58例,病死率为36%。与存活组相比,死亡组APACHEⅡ评分、SOFA评分、呼吸机支持比例、休克比例、去甲肾上腺素使用剂量、ICU住院天数、总住院天数、肝肾功能、心肌酶谱均显著提高,差异有统计学意义(P<0.05)。APACHEⅡ评分、SOFA评分、去甲肾上腺素使用剂量AUC曲线下面积分别为0.928、0.947、0.943,均差异有统计学意义(P<0.05)。与APACHEⅡ评分、SOFA评分相比,去甲肾上腺素使用剂量对严重高乳酸血症的预后判断更具有价值。结论:严重高乳酸血症预后与肝功能、24 h尿量、心肌酶谱、凝血功能等相关,去甲肾上腺素使用剂量、SOFA评分和APACHEⅡ评分是预测高乳酸血症患者预后的危险因素。去甲肾上腺素用剂量对严重高乳酸血症患者的预后判断价值更优于SOFA评分和APACHEⅡ评分。
- 严重高乳酸血症 /
- 病死率 /
- 临床特征 /
- 预后
Abstract: Objective: To explore the clinical characteristics and prognostic of patients with severe hyperlactatemia(Lac>5 mmol/L).Methods: A retrospective study was conducted. The clinical data of patients with plasma Lac over 5 mmol/L within 48 hours of admission was analyzed from December 2016 to May 2019 in emergencymedicine Department of Wuxi People's Hospital Affiliated to Nanjing Medical University. Clinical characteristics were analyzed. Patients were divided into survival group and death group according to 28 d survival. The demographics and clinical data were collected while laboratory parameters including vital signs, 24-hour urine output, routine blood test, blood biochemical tests, coagulation parameters, myocardial enzymes and arterial blood gas analysis were collected.Sequential Organ Failure Assessment(SOFA) 、acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) 、Glasgow coma scale(GCS) were measured. The risk factors of mortality were analyzed by multi-logical analysis.Results: Twenty-one patients were abandont of treatment within 2 hours in emergency medicine Department or date loss. 158 patients were enrolled. There were 100 male patients(63.3%) and 58 female patients(36.7%). Sixty-nine patients were admitted in intensive care unit(ICU 43.6%). Eighty-nine patients were admitted in general ward(56.4%). Major diagnosis was sepsis, followed by cardiopulmonary resuscitation, heat stroke, poisoning, and miocardial infarction.There were 100 patients in the survival group and 58 patients in the death group(with a mortality of 36%). there was no difference in demographics between two groups(P>0.05). The death group serum liver and kidney function, myocardial enzymes, LDH and other indicators were significantly higher than those in survival group as well as those ventilator support, shock, APACHE Ⅱ, SOFA score. Multivariate Logistic regression analysis showed that both SOFA score and APACHE Ⅱ scorewere risk factors associated with 28 d death.Conclusion: The prognosis of hyperlactemia is related to primary disease, PLT, liver function, 24 hours urine volume, myocardial enzyme spectrum, and coagulation, while dose of norepinephrine, high SOFA score and high APACHE score might be independent predictors of poor prognosis in hyperlactemia. The dose of norepinephrine is better than SOFA score and APACHE score for the prognosis of severe hyperlactic acidemia.
- severe hyperlactic acidemia /
- fatality rate /
- clinical features /
- prognosis

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