Comparative analysis of shock index and serum lactate level in patients with traumatic shock
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摘要: 目的 对比休克指数(SI)与血气乳酸水平对院前创伤性休克患者预后的预测价值。方法 选取我院2020年1月－2021年1月期间院前创伤性低血压的174例患者，对入组患者同时进行乳酸水平和SI监测，并进行分组。具体分组如下：①定性分组，乳酸水平≤2 mmol/L定义为正常组，>2 mmol/L定义为增高组; SI≤0.9定义为正常组，>0.9定义为增高组。②定量分组：按血乳酸水平分为≤2.5 mmol/L组、>2.5~5.0 mmol/L组、>5.0~7.5 mmol/L组、>7.5 mmol/L组; 按SI分为≤0.9组和>0.9组。主要观察指标为患者住院7 d SOFA评分，用来评估是否存在多器官功能障碍(MODS); 次要观察指标为应用血管活性药物使用率、机械通气率和住院率。结果 高乳酸水平患者住院7 d MODS发生概率增加(P< 0.01)。乳酸水平增高组，患者机械通气率为18.9%(P< 0.001)，血管活性药物使用率为15.9%(P< 0.001)。在SI正常组，随着血乳酸水平的增高，患者机械通气率、血管活性药物使用率、住院率随之升高(P< 0.01);在SI增高组，血乳酸值>7.5 mmol/L的患者机械通气率、血管活性药物使用及住院率最高(P< 0.01)。结论 在重症创伤性休克患者中，高血乳酸水平能够增加发生MODS的概率。同时，乳酸水平对比SI，在预测重症创伤性休克患者预后的价值更大。Abstract: Objective To compare the shock index with blood lactate level in patients with traumatic shock.Methods Patients with pre-hospital traumatic hypotension from January 2020 to January 2021 were selected. The level of blood lactate and shock index in patients with traumatic shock was detected. Grouping as follows: ①lactate level ≤ 2 mmol/L was defined as normal and>2 mmol/L as higher. Shock index ≤ 0.9 was defined as normal and >0.9 as higher. ②blood lactate level grouping: ≤2.5 mmol/L, >2.5-5.0 mmol/L, >5.0 mmol/L-7.5 mmol/L, >7.5 mmol/L. Shock index grouping: ≤ 0.9 and >0.9. The primary outcome was the presence or absence of MODS at day 7 following injury with SOFA score. Received vasoactive drugs, mechanical ventilation and hospitalisation rate were also recorded as secondary outcomes.Results A total of 174 trauma patients were included in this group. The risk of MODS occurrence in a week after admission was increased in patients with higher lactate level(P< 0.01).Of the patients with elevated lactate level, 37.31% were mechanically ventilated (P< 0.001), 31.34% received vasoactive drugs (P< 0.001), and 79.10% were hospitalized (P< 0.05).In the normal shock index group, the mechanical ventilation rate, acceptance of vasoactive drugs and hospitalization rate was increased with higher lactate level (P< 0.01).In the higher shock index group, patients with lactate value > 7.5 mmol/L had the highest rate of the mechanical ventilation, acceptance of vasoactive drugs and hospitalization(P< 0.01).Conclusion The higher lactate level immediately following traumatic shock is associated with increased MODS. Meanwhile, lactate level also presents as a better prognostic indicator than shock index in patients with critical traumatic shock.
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Key words:
- pre-hospital /
- traumatic shock /
- shock index /
- lactate level
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表 1 住院7d后是否存在多器官功能障碍与各因素间的关系
M(IQR), X±S 因素 SOFA≥6 (81例) SOFA < 6分(93例) P 年龄/岁 51(29~73) 41(29~43) 0.09 女性/例(%) 30(37.0) 27(29.0) 0.30 GCS评分 4(3~7) 9(5~14) 0.02 住院天数/d 23(23±10) 12(12 ± 5) 0.03 28 d病死率/例(%) 9(11.1) 1(1.0) 0.01 基础乳酸值/(mmol·L-1) 4.7 (2.9~7.0) 2.0 (1.1~4.1) < 0.01 SI 1.1 (0.7~1.4) 0.8 (0.6~1.3) 0.07 
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表 2 患者基本情况与SI及乳酸水平间的关系
变量 SI>0.9 (130例) 乳酸>2 mmol/L (132例) P < 60岁/例(%) 53(40.8) 40(30.3) 0.07 创伤发生至到院时间/h 1.2 (0.3~3.9) 0.9 (0.2~2.0) 0.09 格拉斯哥评分 5(2~9) 6(3~10) 0.06 收缩压/mmHg 79.3 (69.7~97.2) 77.4 (58.1~90.3) 0.08 创伤分类/例 0.06 单纯伤 51 47 多发伤 79 85 容量复苏收缩压>80 mmHg/例(%) 60(46.2) 22(16.7) < 0.01
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表 3 乳酸水平与预后关系
因素 乳酸>2 mmol/L /例(%) 乳酸 < 2 mmol/L /例(%) 敏感度/% 特异度/% 阳性预测值/% 阴性预测值/% OR P 机械通气 25(18.9) 4(9.5) 86.21 26.21 18.94 90.48 14.7 < 0.001 血管活性药物 21(15.9) 1(2.3) 95.45 26.97 15.91 97.62 12.3 < 0.001 住院 53(40.2) 30(71.4) 63.86 13.19 40.15 28.57 0.93 >0.05
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表 4 SI与预后关系
因素 SI>0.9/ 例(%) SI≤0.9/ 例(%) 敏感度/% 特异度/% PPV/% NPV/% OR P 机械通气 26(20.0) 3(6.8) 89.66 28.28 20.00 93.18 3.14 >0.05 血管活性药物 17(13.1) 5(11.4) 77.27 25.66 13.08 88.64 3.72 >0.05 住院 49(37.7) 34(77.3) 59.04 10.99 37.39 22.73 0.91 >0.05
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表 5 乳酸水平-SI与患者预后关系
例 因素 SI < 0.9 SI>0.9 敏感度/% 特异度/% OR P 乳酸/(mmol·L-1) 乳酸/(mmol·L-1) ≤2.5 >2.5~ 5 >5.0~ 7.5 >7.5 ≤2.5 >2.5~ 5 >5.0~ 7.5 >7.5 机械通气 0 0 2 5 2 4 6 10 100.00 32.37 6.50 < 0.01 血管活性药物使用 0 0 3 3 1 1 6 8 100.00 39.14 3.98 < 0.01 住院 5 7 7 10 10 11 15 18 93.98 38.41 4.78 < 0.01
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