Objective To explore the prognostic value of early lactate clearance rate in patients with respiratory failure.Methods 117 patients with respiratory failure and elevated blood lactate, admitted into respiratory intensive care unit( RICU) between January 2010 and December 2011, were retrospectively analyzed. Arterial lactate and arterial blood gas were measured before and 12h, 24h, 48h, and 72h after treatment. Then12h lactate clearance rate was calculated. The acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) score was evaluated before and after 12h treatment. The mortality were compared between subgroups with different lactate normalization time( lt;24 h, 24 ～48 h, 48 ～72 h, and gt;72h, respectively) . The clinical data was compared between subgroups with different prognosis ( survival or non-survival ) and between subgroups with different lactate clearance rate( ≥10% as high lactate clearance rate, lt;10% as low lactate clearance rate) . Results The mortality of the patients with lactate normalization time in less 24 hours was significantly lower than that of the patients with lactate normalization time more than 72 hours ( 5. 3% vs. 89. 2% , P lt; 0. 001) . The 12 hour lactate clearance rate of the survival group was significantly higher than that of the non-survival group [ ( 43. 6 ±26. 8) % vs. ( 12. 3 ±39. 1) % , P lt;0. 01] . The mortality of the patients with high lactate clearance rate was significantly lower than that of the patients with lowlactate clearance rate( 25. 8% vs. 71. 4% , P lt;0. 01) . Conclusion Early lactate clearance rate can be used as a marker for prognosis of patients with respiratory failure.
【摘要】 目的 探讨脓毒性休克早期液体复苏的临床反应性。 方法 对2008年2月—2010年2月38例采用早期目标定向治疗方案治疗的脓毒性休克患者按是否存活进行分组，就中心静脉压、心率、平均动脉压、输液量、尿量、血乳酸等指标进行评价。 结果 38例采用早期目标定向治疗方案治疗6 h均达标，存活21例（55.26%），死亡17例（44.74%），两组患者输液总量及输液种类差异无统计学意义（Pgt;0.05），存活组6、24 h尿量及血乳酸清除率明显优于死亡组（Plt;0.05）。 结论 血乳酸清除率及尿量可作为脓毒性休克液体复苏有效的临床监测指标。【Abstract】 Objective To study the clinical response to early fluid resuscitation therapy in septic shock patients. Methods Thirty-eight septic shock patients received early goal-directed therapy (EGDT) in the ICU of our hospital from February 2008 to February 2010. The patients were divided into survival group (n=21) and dead group (n=17). Indexes like central venous pressure (CVP), heart rate (HR), mean arterial pressure (MAP), fluid input, urine output, and blood lactate were evaluated. Results Six hours after the EGDT, the results for the patients were all up to standard. There were 21 cases of survival (55.26%) and 17 cases of death (44.74%). The total fluid input and liquid types were similar in the two groups (Pgt;0.05). The urine output and lactate clearance at hour 6 and 24 for the survival group were better than that for the dead group (Plt;0.05). Conclusion The lactate clearance and urine output can be regarded as an surveillance indicator of fluid resuscitation for patients with septic shock.
【摘要】 目的 评估乳酸清除率与重症创伤患者预后的关系。 方法 回顾性分析2010年1－6月收住曲靖市第一人民医院ICU科的37例重症创伤患者的初始血乳酸值、第2次血乳酸值、乳酸清除率及患者的预后，将患者分为存活组和死亡组，比较两组患者初始血乳酸值、乳酸清除率的差异。 结果 两组患者年龄、性别、初始血乳酸值差异无统计学意义（Pgt;0.05）。存活组血乳酸清除率（48.26±21.57）%明显高于死亡组（11.71±20.88）%，差异有统计学意义（Plt;0.001）；当乳酸清除率≥13%时，能较好地预测患者生存，其灵敏度为96%，特异度为80%。 结论 乳酸清除率可用于评估重症创伤患者的预后。【Abstract】 Objective To evaluate the correlation between prognosis and lactate clearance in severe trauma. Methods The clinical data of 37 patients with severe trauma admitted between January and June 2010 in the First People′s Hospital of Qujin were analyzed retrospectively. These data included initial blood lactate concentration, second blood lactate concentration, lactate clearance rate, and prognosis of the patients. The patients were divided into survivor group and non-survivor group, and the differences of initial blood lactate concentration and lactate clearance rate between them were compared. Results There were no differences in age, sex, and the initial blood lactate concentration (Pgt;0.05) between the two groups. Compared with non-survivors, the survivors had a significantly higher lactate clearance [(48.26±21.57)% vs. (11.71±20.88)%, Plt;0.001]. Patients with a lactate clearance higher than or equal to 13% had a sensitivity of 96%, specificity of 80%, for predicting survival. Conclusion Lactate clearance rate can be used to predict the prognosis of severe trauma.
Objective To explore the predictive value of simplified acute physiological score Ⅱ (SAPS-Ⅱ) combined with lactate clearance rates (LCR) at different moments for mortality in sepsis patients. Methods A total of 188 patients with sepsis admitted in the hospital from April 2020 to February 2023 were selected, who were evaluated using the SAPS-Ⅱ scale. Spectrophotometry was used to detect blood lactate at baseline, after 6h, 12h, 24h, and 48h, then the LCR after 6h, 12h, 24h, and 48h were calculated. The patients were divided into a survival group (n=139) and a death group (n=37) based on 28 day outcome. Logistic regression analysis was used to explore the risk factors of sepsis death, and the efficacy of SAPS-Ⅱ scores combined with LCR at different moments in predicting patient death was analyzed using receiver operating characteristic (ROC) curve. Results Twelve patients fell off, and 37 died in the remaining 176 patients, the mortality rate was 21.02%. The age, temperature, random blood glucose, blood urea nitrogen, serum creatinine, and SAPS- Ⅱ scores in the death group were significantly higher than those in the survival group (P<0.05), while platelet count and LCR at all moments were significantly lower than those in the survival group (P<0.05). The LCR of the death group continued to decrease with time. The trend of changes in the survival group were opposite, and the differences in the two groups between each two moments were statistically significant (P<0.05). The SAPS-Ⅱ scores and LCR at all moments were risk factors for patient death (P<0.05). The SAPS-Ⅱ score and LCR at all moments had predictive value for patient death, and the area under ROC curve of the combined prediction was 0.921 (95%CI 0.825 - 1.000), which was higher than the individual prediction and LCR at each moment combined with SAPS II score prediction (P<0.05). Conclusion The SAPS-Ⅱ scores and LCR at different moments are all related to death of sepsis patients, and the combined prediction of death by the above indicators is highly effective.