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目的探讨乳酸清除率对老年重症创伤患者预后的评估价值,为其临床治疗提供参考依据。方法选取2013年2月—2015年2月舟山医院ICU收治的老年重症创伤患者94例,入ICU时检测患者的动脉血乳酸水平,6 h后复查患者的血乳酸,计算相应乳酸清除率和APACHEⅡ评分,记录患者的预后转归。(1)根据患者的6 h血乳酸清除率10%作为界值,将患者分为高乳酸清除率组(≥10%)67例和低乳酸清除率组(<10%)27例。对比2组患者的初始乳酸值、APACHEⅡ评分、6 h乳酸清除率和28 d病死率。(2)根据疾病的转归,94例患者分为生存组(70例)和死亡组(24例)。对比2组患者初始乳酸值、APACHEⅡ评分、6 h乳酸清除率。结果(1)低乳酸清除率组APACHEⅡ评分和28 d病死率分别为(27.81±5.25)分和40.74%,显著高于高乳酸清除率组[(25.36±5.19)分、19.40%],差异有统计学意义(P<0.05)。(2)生存组APACHEⅡ评分明显低于死亡组,而6h乳酸清除率明显高于死亡组(P<0.05)。结论乳酸清除率能够作为判断老年重症创伤患者病情严重程度及预后评估的重要指标。
Objective To investigate the evaluation value of lactic acid clearance rate on the prognosis of elderly patients with severe trauma and to provide a reference for its clinical treatment. Methods Ninety-four elderly patients with severe trauma admitted to ICU of Zhoushan Hospital from February 2013 to February 2015 were enrolled in this study. Arterial blood lactate levels were measured in patients admitted to ICU. Blood lactic acid was examined after 6 hours. The corresponding lactic acid clearance and APACHEⅡ Score, record the outcome of patients with prognosis. (1) According to the patients’ 6 h blood lactic acid clearance rate of 10%, the patients were divided into high lactate clearance group (≥10%) and low lactate clearance group (27%) (<10%). The initial lactic acid value, APACHE II score, 6 h lactic acid clearance and 28-day mortality were compared between the two groups. (2) According to the outcome of the disease, 94 patients were divided into survival group (70 cases) and death group (24 cases). The initial lactic acid value, APACHEⅡscore and lactate clearance rate of 6 h were compared between two groups. Results (1) APACHE Ⅱ score and 28-day mortality rate in low lactic acid clearance group were (27.81 ± 5.25) and 40.74%, respectively, which were significantly higher than those in high lactic acid clearance group (25.36 ± 5.19) and 19.40% Statistical significance (P <0.05). (2) The APACHEⅡscore of survival group was significantly lower than that of death group, while the lactic acid clearance rate of 6h was significantly higher than that of death group (P <0.05). Conclusion Lactate clearance rate can be used as an important index in judging severity of illness and prognosis in elderly patients with severe trauma.