动脉血乳酸水平及早期乳酸清除率对呼吸机相关性肺炎临床预后的影响
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摘要
目的探讨动脉血乳酸水平及早期乳酸清除率对慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭患者呼吸机相关性肺炎临床预后的影响。方法回顾性分析医院收治的AECOPD合并呼吸衰竭患者198例,根据呼吸机相关性肺炎(VAP)感染转归情况分为好转组(n=29)和恶化组(n=13),将根据0 h动脉血乳酸测定值≥2.0 mmol/L分为乳酸升高组(n=26),反之为乳酸正常组(n=16),根据6 h乳酸清除率>10%分为高乳酸清除率组(n=24),反之为低乳酸清除率组(n=18),对比两组间患者的病情及临床预后差异。结果 48 h、72 h恶化组乳酸值明显高于好转组;乳酸升高组患者住院时间、急性生理与慢性健康状况Ⅱ(APACHEⅡ)得分高于乳酸正常组患者,低乳酸清除率组患者住院时间、多器官功能障碍综合征(MODS)发生率均高于高乳酸清除率组患者,低乳酸清除率组患者APACHEⅡ得分高于高乳酸清除率组患者,低乳酸清除率组病死率明显高于高乳酸清除率组,差异均有统计学意义(P<0.05)。结论 AECOPD合并呼吸衰竭患者动脉血乳酸值、早期乳酸清除率与VAP患者病情预后密切相关,可有效预测患者预后。
OBJECTIVE To explore the influence of arterial blood lactate value and early lactate clearance rate on clinical prognosis of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) patients complicated with respiratory failure. METHODS A total of 198 AECOPD patients complicated with respiratory failure who were treated in the hospital were retrospectively analyzed, the enrolled patients were divided into the improvement group with 29 cases and the deterioration group with 13 cases according to the outcomes of ventilator-associated pneumonia(VAP);the patients with the 0-hour arterial blood lactate value no less than 2.0 mmol/L were assigned as the elevated lactate group with 26 cases, and the patients with the 0-hour arterial blood lactate value less than 2.0 mmol/L were assigned as the normal lactate group with 16 cases; the patients with 6-hour lactate clearance rate more than 10% were assigned as the high lactate clearance rate group with 24 cases, and the patients with the 6-hour lactate clearance rate less than 10% were assigned as the low lactate clearance rate group with 18 cases. The illness condition and clinical outcomes were observed and compared between the two groups of patients. RESULTS The lactate values of the deterioration group were remarkably greater than those of the improvement group at 48 and 72 hours. The length of hospital stay and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score of the elevated lactate group were higher than those of the normal lactate group; the length of hospital stay and incidence of multiple organ dysfunction syndrome(MODS) of the low lactate clearance rate group were higher than those of the high lactate clearance rate group; the APACHEⅡ score of the low lactate clearance rate group was higher than that of the high lactate clearance rate group; the mortality rate of the low lactate clearance rate group was significantly higher than that of the high lactate clearance rate group, and there were significant differences(P<0.05). CONCLUSION The arterial blood lactate value and early lactate clearance rate of the AECOPD patients complicated with respiratory failure are closely associated with the prognosis of the VAP patients, which can effectively prediction of the prognosis.
OBJECTIVE To explore the influence of arterial blood lactate value and early lactate clearance rate on clinical prognosis of acute exacerbation of chronic obstructive pulmonary disease(AECOPD) patients complicated with respiratory failure. METHODS A total of 198 AECOPD patients complicated with respiratory failure who were treated in the hospital were retrospectively analyzed, the enrolled patients were divided into the improvement group with 29 cases and the deterioration group with 13 cases according to the outcomes of ventilator-associated pneumonia(VAP);the patients with the 0-hour arterial blood lactate value no less than 2.0 mmol/L were assigned as the elevated lactate group with 26 cases, and the patients with the 0-hour arterial blood lactate value less than 2.0 mmol/L were assigned as the normal lactate group with 16 cases; the patients with 6-hour lactate clearance rate more than 10% were assigned as the high lactate clearance rate group with 24 cases, and the patients with the 6-hour lactate clearance rate less than 10% were assigned as the low lactate clearance rate group with 18 cases. The illness condition and clinical outcomes were observed and compared between the two groups of patients. RESULTS The lactate values of the deterioration group were remarkably greater than those of the improvement group at 48 and 72 hours. The length of hospital stay and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) score of the elevated lactate group were higher than those of the normal lactate group; the length of hospital stay and incidence of multiple organ dysfunction syndrome(MODS) of the low lactate clearance rate group were higher than those of the high lactate clearance rate group; the APACHEⅡ score of the low lactate clearance rate group was higher than that of the high lactate clearance rate group; the mortality rate of the low lactate clearance rate group was significantly higher than that of the high lactate clearance rate group, and there were significant differences(P<0.05). CONCLUSION The arterial blood lactate value and early lactate clearance rate of the AECOPD patients complicated with respiratory failure are closely associated with the prognosis of the VAP patients, which can effectively prediction of the prognosis.
引文
[1] 陈学昂,李素云,王明航,等.慢性阻塞性肺疾病急性加重期预后影响因素的研究进展[J].中华中医药学刊,2017,35(4):799-802.
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[3] 鲁西亮,黄相增.无创正压通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭的疗效观察[J].实用医学杂志,2015,31(17):2842-2844.
[4] Rinaudo M,Ferrer M,erraneo S,et al.Impact of COPD in the outcome of ICU-acquired pneumonia with and without previous intubation[J].Chest,2015,147(6):1530-1538.
[5] Perilli V,Aceto P,Sacco T,et al.Usefulness of postreperfusion lactate clearance for predicting early graft recovery in liver transplant patients:a single center study[J].Minerva Anestesiol,2018,84(10):1142-1149.
[6] 中华医学会呼吸病学分会慢性阻塞性疾病学组.慢性阻塞性疾病诊疗指南[J].中华内科杂志,2007,46(3):254-261.
[7] 中华医学会重症医学分会.呼吸机相关性肺炎诊断、预防和治疗指南(2013)[J].中华内科杂志,2013,52(6):524-543.
[8] Heys D,Swain A,Knowles S,et al.An audit of change in clinical practice:from oxygen-driven to air-driven nebulisers for prehospital patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD)[J].Intern Med J,2018,48(6):668-673.
[9] 黄晓群,高培阳,张松,等.中西医结合综合方案治疗AECOPD并呼吸衰竭160例[J].辽宁中医杂志,2015,42(9):1714-1716.
[10] Koulenti D,Blot S Dulhunty JM,et al.COPD patients with ventilator-associated pneumonia:implications for management[J].Eur J Clin Microbiol Infect Dis,2015,34(12):2403-2411.
[11] Kollef MH,Micek ST.Recommendations for aerosolized antibiotics in ventilator-associated pneumonia and ventilator-associated tracheobronchitis:too little and too late[J].Clin Microbiol Infect,2017,23(9):593-595.
[12] Hayashida K,Suzuki M,Yonemoto N,et al.Early lactate clearance is associated with improved outcomes in patients with postcardiac arrest syndrome:a prospective,multicenter observational study (SOS-KANTO 2012 Study)[J].Crit Care Med,2017,45(6):e559-e566.
[13] 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(06):952-954.
[14] 盂新科.APACHE评分系统的研究现状及展望[J].中国急救医学,2001,(7):61-63.
[15] 王胜云,王玺,林兆奋,等.动脉血乳酸清除率对脓毒症患者预后的评估价值[J].第二军医大学学报,2015,36(6):670-674.
[16] Hernandez G,Tapia P,AlegríaL,et al.Effects of dexmedetomidine and esmolol on systemic hemodynamics and exogenous lactate clearance in early experimental septic shock[J].Crit Care,2016,20(1):234.
[17] 聂爱玲.动脉血乳酸清除率与呼吸衰竭患者预后的关系[J].山东医药,2015,55(03):71-73.
[18] Nobahar M,Razavi MR,Malek F,et al.Effects of hydrogen peroxide mouthwash on preventing ventilator-associated pneumonia in patients admitted to the intensive care unit[J].Braz J Infect Dis,2016,20(5):444-450.
[19] 张军艳,何启强,周波,等.ICU患者发生呼吸机相关性肺炎的危险因素分析[J].中华医院感染学杂志,2015,25(15):3467-3469.
[2] Kalil AC,Metersky ML,Klompas M,et al.Management of adults with hospital-acquired and ventilator-associated pneumonia:2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society[J].Clin Infect Dis,2016,63(5):575-582.
[3] 鲁西亮,黄相增.无创正压通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭的疗效观察[J].实用医学杂志,2015,31(17):2842-2844.
[4] Rinaudo M,Ferrer M,erraneo S,et al.Impact of COPD in the outcome of ICU-acquired pneumonia with and without previous intubation[J].Chest,2015,147(6):1530-1538.
[5] Perilli V,Aceto P,Sacco T,et al.Usefulness of postreperfusion lactate clearance for predicting early graft recovery in liver transplant patients:a single center study[J].Minerva Anestesiol,2018,84(10):1142-1149.
[6] 中华医学会呼吸病学分会慢性阻塞性疾病学组.慢性阻塞性疾病诊疗指南[J].中华内科杂志,2007,46(3):254-261.
[7] 中华医学会重症医学分会.呼吸机相关性肺炎诊断、预防和治疗指南(2013)[J].中华内科杂志,2013,52(6):524-543.
[8] Heys D,Swain A,Knowles S,et al.An audit of change in clinical practice:from oxygen-driven to air-driven nebulisers for prehospital patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD)[J].Intern Med J,2018,48(6):668-673.
[9] 黄晓群,高培阳,张松,等.中西医结合综合方案治疗AECOPD并呼吸衰竭160例[J].辽宁中医杂志,2015,42(9):1714-1716.
[10] Koulenti D,Blot S Dulhunty JM,et al.COPD patients with ventilator-associated pneumonia:implications for management[J].Eur J Clin Microbiol Infect Dis,2015,34(12):2403-2411.
[11] Kollef MH,Micek ST.Recommendations for aerosolized antibiotics in ventilator-associated pneumonia and ventilator-associated tracheobronchitis:too little and too late[J].Clin Microbiol Infect,2017,23(9):593-595.
[12] Hayashida K,Suzuki M,Yonemoto N,et al.Early lactate clearance is associated with improved outcomes in patients with postcardiac arrest syndrome:a prospective,multicenter observational study (SOS-KANTO 2012 Study)[J].Crit Care Med,2017,45(6):e559-e566.
[13] 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(06):952-954.
[14] 盂新科.APACHE评分系统的研究现状及展望[J].中国急救医学,2001,(7):61-63.
[15] 王胜云,王玺,林兆奋,等.动脉血乳酸清除率对脓毒症患者预后的评估价值[J].第二军医大学学报,2015,36(6):670-674.
[16] Hernandez G,Tapia P,AlegríaL,et al.Effects of dexmedetomidine and esmolol on systemic hemodynamics and exogenous lactate clearance in early experimental septic shock[J].Crit Care,2016,20(1):234.
[17] 聂爱玲.动脉血乳酸清除率与呼吸衰竭患者预后的关系[J].山东医药,2015,55(03):71-73.
[18] Nobahar M,Razavi MR,Malek F,et al.Effects of hydrogen peroxide mouthwash on preventing ventilator-associated pneumonia in patients admitted to the intensive care unit[J].Braz J Infect Dis,2016,20(5):444-450.
[19] 张军艳,何启强,周波,等.ICU患者发生呼吸机相关性肺炎的危险因素分析[J].中华医院感染学杂志,2015,25(15):3467-3469.
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