摘要
Abstract
Objective To observe the change of arterial blood lactate and discuss its influence on the risk stratification of sepsis. Methods The author collected clinical data of 70 patients, checked their arterial blood lactate and PaO2 , et al. Upon admission, and 6 h, 24 h and 48 h later, and calculated the lactate clearance at each corresponding time. Based on the clinical criteria for the worst condition in 24 hours after admission, the APACHE II score of the patients was calculated. Then the patients were grouped and compared according to the level of arterial blood lactate and severity of sepsis. Last, the risk factors for influencing the prognosis of sepsis were analyzed by logistic regression analysis. The receiver - operating - characteristic curve ( ROC ) was drawn and the measure of area below the ROC curve was calculated to see its function in judging the prognosis of sepsis. Results The group with mildly elevating lactate being compared with normal group, APACHE II score, blood sugar, cre-atinine, the incidence of MODS and mortality were higher, but the albumin were lower. The difference was significant ( P < 0. 05 ). The group with severely elevating lactate being compared with the one with mildly elevating lactate, the white blood cells, alanine amiontransferase, creatinine, the incidence of MODS, mortality, days in hospital and breathing machine utilization rate were higher obviously ( P <0. 05 ). The group with extremely severe sepsis being compared with the group with severe sepsis, the rate of lactate clearance was obviously decreased 6 h later, and the difference was significant ( P <0. 05 ). MODS group being compared with the group with extremely severe sepsis, the arterial blood lactate upon admission, 6 h, 24 h and 48 h later, APACHE Ⅱ score and the rate of mortality were higher, and the difference was significant ( P < 0. 05 ), but the rate of lactate clearance 6 h, 24 h and 48 h after admission, PaO2 24 h, 48 h after admission, PLT, CRP and ALB were lowered, and the difference was significant ( P <0. 05 ). Logistic regression analysis indicated that the lactate level upon admission, lactate clearance 6 h later, APACHE Ⅱ score, ALB and Cr were risk factors for prognosis of patients with sepsis; the measure of area below the ROC curve on the 6th day in hospital was 0. 913, the sensitivity was 93. 3% and specificity was 76. 1%. Conclusion Early arterial blood lactate is the biochemical indicator for the severity of sepsis and lactate clearance 6 h after admission is significant for the diagnosis and prognosis in the patients with sepsis.关键词
脓毒症/乳酸/多器官功能衰竭Key words
Sepsis/ Lactic acid/Multiple organ failure分类
医药卫生
