标题：动脉血乳酸相关指标与初始pH值对脓毒性休克患者预后的判断价值
作者：魏亚强 1，辛田田 1，张晓艳 2，贺外信 1，杨蓉 1，杜玲玲 1，王昊 1 延安市人民医院重症医学科 1、检验科 2，陕西 延安 716000
卷次：
2019年30卷13期
【摘要】 目的 探讨动脉血乳酸相关指标与初始pH值对脓毒性休克患者预后的判断价值。方法 回顾性分析2016年6月至2018年6月延安市人民医院 ICU收治的94例脓毒性休克患者的临床资料，根据出院后28 d随访结果将患者分为存活组(n=68)和死亡组(n=26)，比较两组患者的性别、年龄、动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)、平均动脉压(MAP)、急性生理与慢性健康(APACHEⅡ)评分、脓毒症相关序贯器官衰竭(SOFA)评分、不同时间节点动脉血乳酸水平(Lac)及乳酸清除率(LCR)，并利用ROC曲线评估不同时间节点LCR对脓毒性休克患者预后的评估价值。再按照所有患者入 ICU首次动脉血pH值，分为pH≥7.15组和pH<7.15组，比较两组患者的死亡率。结果 存活组和死亡组患者的性别、年龄、PaO2、SaO2及MAP比较差异均无统计学意义(P>0.05)；死亡组APACHEⅡ评分、SOFA评分、0 h-Lac、3 h-Lac、6 h-Lac、24 h-Lac分别为(20.59±1.78)分、(8.80±1.03)分、(6.08±2.46) mmol/L、(5.24±2.16) mmol/L、(4.63±2.17) mmol/L、(4.18±2.01) mmol/L，明显高于存活组的(14.99±2.52)分、(5.76±1.71)分、(4.93±1.77) mmol/L、(3.28±1.42) mmol/L、(1.91±0.95) mmol/L、(1.21±0.63) mmol/L，差异均有统计学意义(P<0.05)；死亡组 3 h-LCR、6 h-LCR、24 h-LCR分别为(19.59±14.81)%、(22.18±23.59)%、(30.06±21.92)%，明显低于存活组的(34.51±10.39)%、(61.99±11.69)%、(75.84±8.49)%，差异均有统计学意义(P<0.05)；ROC曲线分析 3 h-LCR、6 h-LCR、24 h-LCR对死亡预测的曲线下面积(AUC)分别为0.884、0.974、0.995，以24 h-LCR对评估脓毒性休克患者预后具有更好的敏感性(P<0.05)；pH≥7.15组和 pH<7.15组患者的死亡率分别为 23.19%和 40.00%，差异无统计学意义(P>0.05)。结论 APACHE II评分、SOFA评分、不同时间节点的Lac及LCR对脓毒性休克患者的预后均具有一定的评估价值。患者入院初始pH水平与预后关系不大。
【关键词】 多器官功能障碍；脓毒症休克；乳酸；初始pH值；清除率；预后
【中图分类号】 R631 【文献标识码】 A 【文章编号】 1003—6350（2019）13—1677—03Value of arterial blood lactate related index and initial pH value in the prognosis of patients with septic shock.WEI Ya-qiang 1, XIN Tian-tian 1, ZHANG Xiao-yan 2, HE Wai-xin 1, YANG Rong 1, DU Ling-ling 1, WANG Hao 1.Department of ICU 1, Department of Clinical Laboratory 2, Yan'an People's Hospital, Yan'an 716000, Shaanxi, CHINA
【Abstract】 Objective To investigate the prognostic value of arterial blood lactic acid related indexes and ini-tial pH value in patients with septic shock. Methods A retrospective analysis was performed to analyze the clinical da-ta of 94 patients with septic shock admitted to the Intensive Care Unit of Yan'an People's Hospital from June 2016 toJune 2018. The subjects were divided into survival group (n=68) and death group (n=26) according to the 28th follow-upresults. The gender, age, partial pressure of oxygen (PaO2), blood oxygen saturation (SaO2), mean artery pressure (MAP),acute physiology and chronic health evaluation (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score,arterial blood lactate (Lac) level, and lactate clearance rate (LCR) at different time points were compared between thetwo groups. ROC curve was used to assess the value of LCR at different time points in evaluating the prognosis of pa-tients. According to the first arterial blood pH of the patients in ICU, they were divided into pH≥7.15 group and pH<7.15 group, and then the mortality rate of the two groups was compared. Results There was no significant difference insex, age, PaO2, SaO2, and MAP between survival group and death group (P>0.05). APACHE Ⅱ score, SOFA score, Laclevels at 0 h, 3 h, 6 h, 24 h in death group were 20.59±1.78, 8.80±1.03, (6.08±2.46) mmol/L, (5.24±2.16) mmol/L, (4.63±2.17) mmol/L, (4.18±2.01) mmol/L, versus 14.99±2.52, 5.76±1.71, (4.93±1.77) mmol/L, (3.28±1.42) mmol/L, (1.91±0.95) mmol/L, (1.21±0.63) mmol/L in the survival group (P<0.05). The LCR at 3 h, 6 h, and 24 h in death group were(19.59 ± 14.81)% , (22.18 ± 23.59)% , (30.06 ± 21.92)% , which were significantly lower than (34.51 ± 10.39)% , (61.99 ±11.69)%, (75.84±8.49)% in survival group (P<0.05). ROC curve analysis showed that the AUC of LCR at 3 h, 6 h, and24 h for death prediction were 0.884, 0.974, and 0.995, respectively (P<0.05). The mortality rates were 23.19% in pH≥7.15 group and 40.00% in pH<7.15 group, and there was no statistically significant difference between the two groups(P>0.05). Conclusion APACHE Ⅱ score, SOFA score, Lac level, and LCR at different time points have certain valuefor evaluating the prognosis of patients with septic shock. The initial pH level of patients admitted to hospital has little re-lationship with prognosis.
【Key words】 Multiple organ dysfunction; Sepsis shock; Lactate; Initial pH value; Clearance rate; Prognosis
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