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目的探讨血乳酸清除率、急性生理学与慢性健康状况(APACHEⅡ)评分与重症肺炎预后的关系。方法收集入住ICU的重症肺炎患者32例,检测患者入院即刻和入院后6、24、48h动脉血乳酸值,计算乳酸清除率;入院后24、48h行APACHEⅡ评分。结果 32例中,入院28d存活19例(存活组),死亡13例(死亡组)。入院6、24、48h,存活组血乳酸清除率分别为(14.3±7.2)%、(25.5±8.3)%、(48.6±12.5)%,死亡组血乳酸清除率分别为(7.0±5.8)%、(8.8±7.4)%、(12.8±11.4)%,存活组动脉血乳酸清除率高于死亡组(P<0.05)。入院24、48h,存活组APACHEⅡ评分为(20.6±4.8)分、(17.6±6.2)分,死亡组APACHEⅡ评分为(24.7±6.8)分、(28.2±7.5)分,存活组APACHEⅡ评分低于死亡组(P<0.05)。结论入院48h内乳酸清除率及APACHEⅡ评分对判断重症肺炎患者预后有较高的价值。
Objective To investigate the relationship between serum lactate clearance rate, acute physiology and chronic health status (APACHEⅡ) score and the prognosis of severe pneumonia. Methods Thirty-two patients with severe pneumonia admitted to the ICU were enrolled in this study. The arterial blood lactic acid levels were measured immediately after admission and at 6, 24 and 48 hours after admission. The lactic acid clearance rate was calculated. APACHEⅡscore was performed 24 and 48 hours after admission. Results In 32 cases, 19 cases survived 28 days after admission and 13 cases died. The lactic acid clearance rates of survivors were (14.3 ± 7.2)%, (25.5 ± 8.3)% and (48.6 ± 12.5)% respectively at 6, 24 and 48 hours after admission. , (8.8 ± 7.4)% and (12.8 ± 11.4)% respectively. The rate of lactic acid clearance in the survival group was higher than that in the death group (P <0.05). The APACHEⅡscore of survivors was (20.6 ± 4.8) points and (17.6 ± 6.2) points at 24 and 48 hours after admission. APACHEⅡ score of death group was (24.7 ± 6.8) and (28.2 ± 7.5) Group (P <0.05). Conclusion The rate of lactic acid clearance and APACHEⅡ score within 48h after admission is of great value in judging the prognosis of patients with severe pneumonia.