动脉血乳酸及早期乳酸清除率对COPD合并呼吸衰竭患者预后的评估价值
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摘要
目的分析动脉血乳酸及早期乳酸清除率(LCR)对慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者预后的评估价值。方法分析本院80例COPD合并呼吸衰竭患者的临床资料,并根据其入院时的动脉血乳酸水平,将患者分为乳酸正常组、轻度升高组和重度升高组,比较组间的临床相关指标。同时根据患者的6 h乳酸清除率,将患者分为高LCR组和低LCR组,比较2组治疗前、治疗后6 h乳酸水平和动脉血气分析结果,并分析其与患者预后的相关性。结果乳酸轻度组、重度升高组的APACHEⅡ、机械通气时间、住院时间、30 d病死率均较乳酸正常组增加(P<0.05);治疗后高LCR组患者的动脉血乳酸、APACHEⅡ评分均低于治疗前,血气分析结果较治疗前均有显著改善(P<0.05);高LCR组的各指标改善情况均显著优于低LCR组(P<0.05)。患者预后的危险因素为APACHEⅡ、机械通气时间,6 h LCR是影响患者预后的保护因素(P<0.05)。结论早期乳酸清除率与呼吸衰竭患者的病情变化密切相关,并对患者的预后具有较好的参考价值。
Objective To analyze the assessment value of arterial blood lactic acid and early lactate clearance rate(LCR) in the prognosis of chronic obstructive pulmonary disease(COPD) patients with respiratory failure. Methods The clinical data of 80 COPD patients with respiratory failure in our hospital were analyzed. According to the arterial blood lactic acid levels at admission, patients with normal lactic acid, mildly elevated and severely elevated groups were compared. At the same time, according to the patient's 6 h lactate clearance rate, the patients were divided into high LCR group and low LCR group to compare the lactate levels and arterial blood gas analysis results before and after treatment, and the correlation with the prognosis of the patients was analyzed. Results APACHEⅡ, mechanical ventilation time, hospitalization time and 30-day mortality rate of the mild and severe lactic acid groups were significantly higher than those of the normal lactic acid group(P<0.05). Blood lactate and APACHEⅡ scores were significantly lower than before treatment, and blood gas analysis results were significantly improved compared with before treatment(P<0.05). The improvement of each index in the high LCR group was significantly better than that in the low LCR group(P<0.05). The risk factors for patient's prognosis were patient's APACHEⅡ and mechanical ventilation time, and 6 h LCR was a protective factor influencing the prognosis of patients(P<0.05). Conclu-sion The early lactate clearance rate is closely related to the change of the condition of patients with respiratory failure, and has a good reference value for the prognosis of patients.
Objective To analyze the assessment value of arterial blood lactic acid and early lactate clearance rate(LCR) in the prognosis of chronic obstructive pulmonary disease(COPD) patients with respiratory failure. Methods The clinical data of 80 COPD patients with respiratory failure in our hospital were analyzed. According to the arterial blood lactic acid levels at admission, patients with normal lactic acid, mildly elevated and severely elevated groups were compared. At the same time, according to the patient's 6 h lactate clearance rate, the patients were divided into high LCR group and low LCR group to compare the lactate levels and arterial blood gas analysis results before and after treatment, and the correlation with the prognosis of the patients was analyzed. Results APACHEⅡ, mechanical ventilation time, hospitalization time and 30-day mortality rate of the mild and severe lactic acid groups were significantly higher than those of the normal lactic acid group(P<0.05). Blood lactate and APACHEⅡ scores were significantly lower than before treatment, and blood gas analysis results were significantly improved compared with before treatment(P<0.05). The improvement of each index in the high LCR group was significantly better than that in the low LCR group(P<0.05). The risk factors for patient's prognosis were patient's APACHEⅡ and mechanical ventilation time, and 6 h LCR was a protective factor influencing the prognosis of patients(P<0.05). Conclu-sion The early lactate clearance rate is closely related to the change of the condition of patients with respiratory failure, and has a good reference value for the prognosis of patients.
引文
[1] 张英民,毛毅敏,孙瑜霞.老年慢性阻塞性肺疾病患者肺部感染的危险因素分析[J].中华医院感染学杂志,2014,24(14):42-47.
[2] 周蓉靖,白春峰,戴文珍,等.脑梗死患者肺部感染临床特点与危险因素分析[J].中华医院感染学杂志,2015,12(17):3970-3972.
[3] 安莹波.早期动脉血乳酸水平和乳酸清除率对评估严重脓毒症患者预后的临床价值[J].微循环学杂志,2013,23(3):50-51.
[4] Blow O,Magliore L,Claridge J A,et al.The golden hour and the silver day:detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma[J].J Trauma,1999,47(5):964-969.
[5] 徐小强,罗琼湘,胡春林,等.早期动脉血乳酸清除率在评估严重脓毒症患者预后中的价值[J].中国急救医学,2015,33(1):34-36.
[6] 乐健伟,朱建华.早期乳酸清除率评估术后脓毒症休克患者预后的临床价值[J].浙江医学,2012,34(2):140-141.
[7] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.COPD诊治指南(2007年修订版)[J].继续医学教育,2007,21(2):31-42.
[8] 时永红,毕淑敏,张春梅.老年慢性阻塞性肺疾病患者肺部真菌感染的危险因素分析[J].中华医院感染学杂志,2013,23(15):3810-3812.
[9] Uzoigwe CE,Venkatesan M,Smith R,et al.Serum lactate is a prognostic indicator in patients with hip fracture[J].Hip International,2012,22(5):580-584.
[10] Shapiro NI,Howell MD,Talmor D,et al.Serum lactate as a predictor of mortality in emergency department patients with infection[J].Ann Emerg Med,2005,45(5):524-528.
[11] 徐梅华,蔡克银.早期乳酸清除率对老年呼吸衰竭患者预后的评估[J].实用老年医学,2012,26(5):388-390.
[12] 程静,马乐,苏春芳.动脉血乳酸及早期乳酸清除率与老年COPD合并呼吸衰竭患者预后的相关性[J].实用医学杂志,2016,32(6):952-954.
[13] 袁志,沈华浩,张根生,等.早期乳酸清除率对重症慢性阻塞性肺疾病患者预后的评估[J].中华急诊医学杂志,2011,20(7):742-745.
[14] 熊新发,叶辉,杨桂美.早期乳酸清除率在AECOPD并呼吸衰竭患者预后评估中的作用[J].医学综述,2016,34(3):617-619.
[15] 陈素芹,程改存,陈晨,等.6 h乳酸清除率评估慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭患者预后的临床意义[J].中国全科医学,2012,15(5):519-521.
[16] 何敏,周浴,朱建勇,等.动脉血乳酸及早期乳酸清除率对COPD合并呼吸衰竭患者预后的评估价值[J].海南医学院学报,2017,23(2):169-171.
[17] Seeger FH,Toenne M,Lehmann R,et al.Simplistic approach to prognosis after cardiopulmonary resuscitation-value of pH and lactate[J].J Crit Care,2013,28(3):13-20.
[18] 徐吉,潘怀富.机械通气早期乳酸清除率对重症COPD患者预后的影响[J].临床医学,2014,34(10):89-90.
[19] Mato AR,Luger SM,Heitjan DF,et al.Elevation in serum lactate at the time of febrile neutropenia (FN) in hemodynamically-stable patients with hematologic malignancies (HM) is associated with the development of septic shock within 48 hours[J].Cancer Biol Ther,2010,9(8):585-598.
[20] 茹晃耀,劳志刚,戴良成,等.早期血乳酸清除率对AECOPD并呼吸衰竭患者预后评估的意义[J].中国医药科学,2013,3(9):70-71.
[2] 周蓉靖,白春峰,戴文珍,等.脑梗死患者肺部感染临床特点与危险因素分析[J].中华医院感染学杂志,2015,12(17):3970-3972.
[3] 安莹波.早期动脉血乳酸水平和乳酸清除率对评估严重脓毒症患者预后的临床价值[J].微循环学杂志,2013,23(3):50-51.
[4] Blow O,Magliore L,Claridge J A,et al.The golden hour and the silver day:detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma[J].J Trauma,1999,47(5):964-969.
[5] 徐小强,罗琼湘,胡春林,等.早期动脉血乳酸清除率在评估严重脓毒症患者预后中的价值[J].中国急救医学,2015,33(1):34-36.
[6] 乐健伟,朱建华.早期乳酸清除率评估术后脓毒症休克患者预后的临床价值[J].浙江医学,2012,34(2):140-141.
[7] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.COPD诊治指南(2007年修订版)[J].继续医学教育,2007,21(2):31-42.
[8] 时永红,毕淑敏,张春梅.老年慢性阻塞性肺疾病患者肺部真菌感染的危险因素分析[J].中华医院感染学杂志,2013,23(15):3810-3812.
[9] Uzoigwe CE,Venkatesan M,Smith R,et al.Serum lactate is a prognostic indicator in patients with hip fracture[J].Hip International,2012,22(5):580-584.
[10] Shapiro NI,Howell MD,Talmor D,et al.Serum lactate as a predictor of mortality in emergency department patients with infection[J].Ann Emerg Med,2005,45(5):524-528.
[11] 徐梅华,蔡克银.早期乳酸清除率对老年呼吸衰竭患者预后的评估[J].实用老年医学,2012,26(5):388-390.
[12] 程静,马乐,苏春芳.动脉血乳酸及早期乳酸清除率与老年COPD合并呼吸衰竭患者预后的相关性[J].实用医学杂志,2016,32(6):952-954.
[13] 袁志,沈华浩,张根生,等.早期乳酸清除率对重症慢性阻塞性肺疾病患者预后的评估[J].中华急诊医学杂志,2011,20(7):742-745.
[14] 熊新发,叶辉,杨桂美.早期乳酸清除率在AECOPD并呼吸衰竭患者预后评估中的作用[J].医学综述,2016,34(3):617-619.
[15] 陈素芹,程改存,陈晨,等.6 h乳酸清除率评估慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭患者预后的临床意义[J].中国全科医学,2012,15(5):519-521.
[16] 何敏,周浴,朱建勇,等.动脉血乳酸及早期乳酸清除率对COPD合并呼吸衰竭患者预后的评估价值[J].海南医学院学报,2017,23(2):169-171.
[17] Seeger FH,Toenne M,Lehmann R,et al.Simplistic approach to prognosis after cardiopulmonary resuscitation-value of pH and lactate[J].J Crit Care,2013,28(3):13-20.
[18] 徐吉,潘怀富.机械通气早期乳酸清除率对重症COPD患者预后的影响[J].临床医学,2014,34(10):89-90.
[19] Mato AR,Luger SM,Heitjan DF,et al.Elevation in serum lactate at the time of febrile neutropenia (FN) in hemodynamically-stable patients with hematologic malignancies (HM) is associated with the development of septic shock within 48 hours[J].Cancer Biol Ther,2010,9(8):585-598.
[20] 茹晃耀,劳志刚,戴良成,等.早期血乳酸清除率对AECOPD并呼吸衰竭患者预后评估的意义[J].中国医药科学,2013,3(9):70-71.
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