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目的急性颅脑外伤后,患者动脉血乳酸及乳酸清除率在一定程度上反应了病情严重程度。文中旨在探讨动脉血乳酸及乳酸清除率在评估颅脑外伤患者预后的价值。方法回顾性分析南京军区南京总医院急诊科2015年2月至2015年11月收治的颅脑外伤患者94例基本资料。在患者入院时立即进行GCS评分,动脉血乳酸、血压、心率的测定,在入院6 h后再次测定动脉血乳酸浓度,计算其动脉血乳酸清除率。将所有患者分别按格拉斯哥昏迷评分分值分为轻度组(13~15分)、中度组(9~12分)和重度组(3~8分),并根据预后分为死亡组和存活组,分别比较各组的动脉血乳酸值及乳酸清除率。结果轻、中、重度3组动脉血乳酸浓度间差异有统计学意义(F=19.99,P<0.01),且6 h乳酸清除率组间差异亦有统计学意义(F=6.21,P<0.01)。死亡组的初始血乳酸浓度明显高于存活组[(4.20±1.36)mmol/L vs(1.58±0.93)mmol/L],差异有统计学意义(t=-9.78,P<0.01);死亡组的6 h乳酸清除率明显低于存活组[(31.73±12.84)%vs(46.25±12.01)%],差异有统计学意义(t=4.55,P<0.01)。结论在颅脑外伤的患者中,动脉血乳酸及6 h乳酸清除率可较好地评估患者的病情程度及预后,在临床中具有重要应用价值。
Objective After acute craniocerebral trauma, the arterial blood lactic acid and lactic acid clearance rates of patients reflect the severity of the disease to a certain extent. This article aims to investigate the value of arterial blood lactate and lactate clearance in the evaluation of prognosis of patients with craniocerebral trauma. Methods A retrospective analysis of 94 cases of craniocerebral trauma patients admitted to Emergency Department of Nanjing General Hospital of Nanjing Military Region from February 2015 to November 2015 was performed. The GCS score, arterial blood lactate, blood pressure and heart rate were measured immediately after admission. The arterial blood lactic acid concentration was measured again 6 h after admission, and the arterial blood lactate clearance rate was calculated. All patients were divided into mild group (13-15 points), moderate group (9-12 points) and severe group (3-8 points) according to Glasgow coma score, and divided into death group and survival according to prognosis The arterial blood lactic acid and lactic acid clearance were compared between groups. Results There was significant difference between the arterial blood lactic acid concentrations in three groups (F = 19.99, P <0.01), and the lactic acid clearance rate at 6 h also had statistical significance (F = 6.21, P <0.01 ). The initial blood lactic acid concentration in the death group was significantly higher than that in the survival group [(4.20 ± 1.36) mmol / L vs (1.58 ± 0.93) mmol / L], the difference was statistically significant (t = -9.78, P <0.01) (31.73 ± 12.84)% vs (46.25 ± 12.01)%], the difference was statistically significant (t = 4.55, P <0.01). Conclusion In patients with craniocerebral trauma, arterial blood lactate and 6 h lactic acid clearance rate can better assess the patient’s condition and prognosis, which has important clinical value.