早期乳酸清除率对严重脓毒症和脓毒性休克预后的影响

张亮

doi:10.13898/j.cnki.issn.1000-2200.2016.04.024

早期乳酸清除率对严重脓毒症和脓毒性休克预后的影响

张亮

安徽省马鞍山市人民医院重症医学科, 243000

作者简介: 张亮(1980-),男,主治医师.

中图分类号: R631.2

The relationship between the early lactate clearance rate and the prognosis of patients with severe sepsis and septic shock

ZHANG Liang

Intensive Care Unit, Maanshan People's Hospital, Maanshan Anhui 243000, China
CLC number: R631.2

摘要: 目的:探讨早期乳酸清除率对严重脓毒症及脓毒性休克预后的影响。方法:收集112例严重脓毒症及脓毒性休克病例,监测其入院时及入院6 h的乳酸水平,计算乳酸清除率。将患者分为高乳酸清除率(乳酸清除率>10%)组和低乳酸清除率(乳酸清除率 ≤ 10%)组,比较2组病死率、初始乳酸水平和APACHE Ⅱ评分。随访30 d,根据患者生存情况将患者分为存活组和死亡组,比较2组动脉血乳酸水平、早期乳酸清除率及APACHE Ⅱ评分。结果:高乳酸清除率组和低乳酸清除率组初始乳酸水平差异有统计学意义(P<0.01)。高乳酸清除率组病死率和APACHE Ⅱ评分均明显低于低乳酸清除率组(P<0.01),随访30 d后,病死45例,存活67例,存活组APACHE Ⅱ评分明显低于病死组(P<0.01)。存活组早期乳酸清除率明显高于病死组(P<0.01)。结论:早期乳酸清除率可以作为判断严重脓毒症及脓毒性休克患者预后的一个重要指标。
- 脓毒症 /
- 乳酸清除率 /
- 脓毒性休克
Abstract: Objective: To discuss the effects of early lactate clearance rate on the prognosis of patients with severe sepsis and septic shock. Methods: The lactic acid levels in 112 patients with severe sepsis and septic shock were measured at admission and at 6 hours of admission, and the lactate clearance rates of all cases were calculated. All patients were divided into the high lactate clearance rate group(the lactate clearance rate more than 10%) and low lactate clearance rate group(the lactate clearance rate less than 10%). The mortality, initial level of lactic acid and APACHE Ⅱ score between two groups were compared. All patients were followed up for 30 days, and divided into the survival group and death group according to their survival. The arterial blood lactate level, early lactate clearance rate and APACHE Ⅱ score between two groups were compared. Results: The difference of the initial level of lactic acid between the high lactate clearance rate group and low lactate clearance rate group was statistically significant(P<0.01). The mortality and APACHE Ⅱ score in high lactate clearance rate group were significantly lower than those in low lactate clearance rate group(P<0.01). Fifty-five cases died and 67 cases survived after 30 days of following up. The APACHE Ⅱ score in survival group was significantly lower than that in mortality group(P<0.01). The lactate clearance rate in survival group in the early period was significantly higher than that in mortality group(P<0.01). Conclusions: The early lactate clearance rate is an important index and more reliability in judging the prognosis of patients with severe sepsis and septic shock.
- sepsis /
- lactate clearance rate /
- septic shock

[1]	沈晔,吴双华,潘景业,等.碱剩余早期动态变化和乳酸清除率对脓毒症患者预后的评估[J].中国急救复苏与灾害医学杂志,2008,3(11):668.
[2]	DELLINGER RP,LEVY MM,RH ODES A,et al.Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock,2012[J].Intensive Care Med,2013,39(2):165.
[3]	ELLINGER RP,CADET JM,MASUR H,et al.Surviving sepsis campaign guidelines for management of sever sepsis and septic shock[J].Crit Care Med,2004,32:858.
[4]	RHEE JY,KWON KT,KI HK,et al.Scoring systems for prediction of mortality in patients with intensive care unit-acquired sepsis:a comparison of the Pitt bacteremia score and the Acute Physiology and Chronic Health Evaluation Ⅱ scoring systems[J].Shock,2009,31(2):146.
[5]	KANOORE VS,DUBIN A,INCE C.The microcirculation as a therapeutic target in the treatment of sepsis and shock[J].Semin Respir Crit Care Med,2011,32(5):558.
[6]	VORWERK C,LORYMAN B,COATS TJ,et al.Prediction of mortality in adult emergency department patients with sepsis[J].E-merg Med J,2009,26(4):254.
[7]	SHAPIRO NI,ANGUS DC.A review of therapeutic attempts to recruit the microcirculation in patients with sepsis[J].Minerva Anestesiol,2014,80(2):225.
[8]	ZHAO N,TIAN HH,LI Z,et al.Risk factors and early diagnosis of acute kidney injury in patients with sepsis[J].Zhonghua Wei Zhong Bing Ji Jiu Yi Xue,2013,25(9):542.
[9]	JESMIN S,WADA T,GANDO S,et al.The dynamics of angiogenic factors and their soluble receptors in relation to organ dysfunction in disseminated intravascular coagulation associated with sepsis[J].Inflammation,2013,36(1):186.
[10]	郭健,夏一春,汤瑾,等.乳酸和血清胱抑素C评估脓毒症患者病情及预后的临床价值[J].蚌埠医学院学报,2015,40(2):168.
[11]	LONDOÑO J,LEÓN AL,RODRÍGUEZ F,et al.Serum lactate in the emergency department as a prognostic factor in patients with sepsis without hypotension[J].Med Clin (Barc),2013,141(6):246.
[12]	JONES AE.Lactate clearance for assessing response to resuscitation in severe sepsis[J].Acad Emerg Med,2013,20(8):844.

[1]	周子翔 , 郑传明 , 徐志鹏 , 宋琦 , 王振杰 . 血清淀粉样蛋白A、肝素结合蛋白及降钙素原在胆道感染并发脓毒症病人中的预测价值. 蚌埠医学院学报, 2023, 48(11): 1520-1524. doi: 10.13898/j.cnki.issn.1000-2200.2023.11.008
[2]	陈城 , 崔静 , 纪小奇 , 姚莉 . 脓毒性休克并发急性肾损伤的危险因素研究. 蚌埠医学院学报, 2021, 46(5): 639-641. doi: 10.13898/j.cnki.issn.1000-2200.2021.05.020
[3]	张博 , 丁开方 , 杨东星 , 顾庆 , 王路娥 . 乳酸清除率联合心肌坏死标志物在感染性休克患者预后判断中的临床价值. 蚌埠医学院学报, 2017, 42(2): 191-194. doi: 10.13898/j.cnki.issn.1000-2200.2017.02.017
[4]	郭健 , 夏一春 , 汤瑾 , 钱风华 , 赵雷 , 钱义明 . 乳酸和血清胱抑素C评估脓毒症患者病情及预后的临床价值. 蚌埠医学院学报, 2015, 40(2): 168-170,173. doi: 10.13898/j.cnki.issn.1000-2200.2015.02.009
[5]	吴颖 , 崔朝勃 , 亢宏山 , 赵媛媛 , 刘淑红 . 乌司他丁对脓毒症患者血清肿瘤坏死因子-α、白细胞介素10、肌钙蛋白I和C反应蛋白水平的影响. 蚌埠医学院学报, 2016, 41(12): 1635-1638. doi: 10.13898/j.cnki.issn.1000-2200.2016.12.031
[6]	李徽徽 , 汪华学 , 柴继侠 , 于影 , 叶红伟 , 高琴 , 陈晓蓉 . 脓毒症大鼠肾脏结构和功能的改变及核因子-B的表达. 蚌埠医学院学报, 2013, 37(5): 524-527.
[7]	马云 , 崔虎 . 他汀类药物治疗脓毒症作用机制的研究进展. 蚌埠医学院学报, 2012, 36(4): 483-486.
[8]	孙文斌 , 梁宗敏 . 塞来昔布对脓毒症的疗效及可能机制. 蚌埠医学院学报, 2017, 42(3): 342-344. doi: 10.13898/j.cnki.issn.1000-2200.2017.03.018
[9]	陆国玉 , 佘剑雄 , 陶言言 , 肖恒 . 参附注射液对脓毒症病人急性肾损伤的效果. 蚌埠医学院学报, 2019, 44(7): 872-875. doi: 10.13898/j.cnki.issn.1000-2200.2019.07.008
[10]	孙芳园 , 张纬 , 袁林 , 汪淼 , 许开亮 , 韩耀国 , 陈刚 , 沈伟鸿 . 电针对脓毒症心肌损伤病人microRNA-133a表达影响. 蚌埠医学院学报, 2020, 45(3): 335-337, 341. doi: 10.13898/j.cnki.issn.1000-2200.2020.03.013
[11]	陶言言 , 齐本权 , 张弘 , 陆国玉 , 吴晓飞 . 参附注射液联合乌司他丁治疗脓毒症的疗效观察. 蚌埠医学院学报, 2020, 45(5): 581-584. doi: 10.13898/j.cnki.issn.1000-2200.2020.05.006
[12]	王莉莉 , 刘元税 . 循环监测在脓毒症病人液体复苏中的应用. 蚌埠医学院学报, 2023, 48(6): 838-840. doi: 10.13898/j.cnki.issn.1000-2200.2023.06.029
[13]	袁晓宇 , 袁菊萍 , 黄中伟 . 血必净对热休克蛋白90在脓毒症小鼠肝肺损伤中表达的影响. 蚌埠医学院学报, 2016, 41(6): 717-721. doi: 10.13898/j.cnki.issn.1000-2200.2016.06.004
[14]	徐波 , 吴晓飞 , 王冉 . 降钙素原、C反应蛋白、血小板及嗜酸性粒细胞对脓毒症患者预后的影响. 蚌埠医学院学报, 2016, 41(12): 1589-1591. doi: 10.13898/j.cnki.issn.1000-2200.2016.12.015
[15]	洪峰 , 周大勇 . 降钙素原、血小板及D-二聚体检测在脓毒症预后中的价值. 蚌埠医学院学报, 2018, 43(11): 1471-1473. doi: 10.13898/j.cnki.issn.1000-2200.2018.11.022
[16]	路坤 , 何先弟 , 汪华学 , 张影影 . 脓毒症相关急性肾损伤在连续肾替代治疗早期降钙素原的预测价值. 蚌埠医学院学报, 2020, 45(1): 60-63. doi: 10.13898/j.cnki.issn.1000-2200.2020.01.015
[17]	李小双 , 刘丽 , 罗菲菲 , 解启莲 . 小剂量地塞米松对脓毒症小鼠 CD11b⁺Gr-1⁺髓源抑制性细胞的影响. 蚌埠医学院学报, 2015, 40(6): 712-715. doi: 10.13898/j.cnki.issn.1000-2200.2015.06.004
[18]	陈康 , 刘伯飞 , 顾小宇 , 许海军 , 吴振东 , 秦夏 . 不同营养供给方式对无胃肠道功能障碍脓毒症患者血糖控制和胃肠功能障碍发生的影响. 蚌埠医学院学报, 2015, 40(10): 1341-1343.
[19]	王娇 , 邹琪 , 刘成 , 楚新旭 , 汪华学 . 维生素C预处理对脓毒症小鼠肺组织miR126a-5p、miR155-5p表达的影响. 蚌埠医学院学报, 2022, 47(4): 433-437. doi: 10.13898/j.cnki.issn.1000-2200.2022.04.003
[20]	朱刚 , 刘宝 . 血清C反应蛋白、降钙素原水平对脓毒症的诊断价值. 蚌埠医学院学报, 2011, 36(12): 1336-1338.

点击查看大图

计量

文章访问数: 3823
HTML全文浏览量: 409
PDF下载量: 125
被引次数: 0

姓名
邮箱
手机号码
标题
留言内容
验证码

留言板

早期乳酸清除率对严重脓毒症和脓毒性休克预后的影响

作者简介: 张亮(1980-),男,主治医师.

The relationship between the early lactate clearance rate and the prognosis of patients with severe sepsis and septic shock

计量

早期乳酸清除率对严重脓毒症和脓毒性休克预后的影响

作者简介: 张亮(1980-),男,主治医师.

English Abstract

The relationship between the early lactate clearance rate and the prognosis of patients with severe sepsis and septic shock

全文HTML

目录

留言板

早期乳酸清除率对严重脓毒症和脓毒性休克预后的影响

作者简介: 张亮(1980-),男,主治医师.

The relationship between the early lactate clearance rate and the prognosis of patients with severe sepsis and septic shock

计量

出版历程

早期乳酸清除率对严重脓毒症和脓毒性休克预后的影响

作者简介: 张亮(1980-),男,主治医师.

English Abstract

The relationship between the early lactate clearance rate and the prognosis of patients with severe sepsis and septic shock

全文HTML

目录