目的 動(dòng)態(tài)觀察外科重癥膿毒癥患者血清血乳酸及D-二聚體水平與預(yù)后的關(guān)系。方法回顧性分析55 例符合重癥膿毒癥標(biāo)準(zhǔn)的患者, 比較8、16、24、48、72 和168 h 的血乳酸變化和24、72、 168 h的D-二聚體變化。結(jié)果 其中34 例存活, 21 例死亡, 死亡率為38. 2%, 均死于多器官功能衰竭。 34 例存活組血乳酸48 h 內(nèi)均達(dá)到正常, 而21 例死亡組直至第168 h仍明顯高于存活組和正常值( P lt; 0. 05) 。死亡組24 h D-二聚體水平比存活組明顯升高( 為正常值的5 倍) ( P lt;0. 05) , 在72 和168 h 兩組無顯著差異( P gt;0. 05) , 但兩組D-二聚體仍明顯升高( 為正常值的2. 5 倍) 。若以24 h 血乳酸和24 h D-二聚體預(yù)測(cè)死亡能力作ROC 曲線,24 h 血乳酸和D-二聚體的預(yù)測(cè)死亡能力相當(dāng)。結(jié)論 動(dòng)態(tài)監(jiān)測(cè)1 周內(nèi)血乳酸水平是判斷重癥膿毒癥患者預(yù)后的一個(gè)重要指標(biāo), 血乳酸48 h 內(nèi)降至正常, 預(yù)后良好; 隨后的血乳酸仍高于正常, 預(yù)后差。24 h 血乳酸水平與24 h D-二聚體水平預(yù)測(cè)死亡能力相當(dāng)。
引用本文： 黃順偉,管向東. 重癥膿毒癥患者動(dòng)態(tài)監(jiān)測(cè)血乳酸及 D-二聚體的臨床研究. 中國呼吸與危重監(jiān)護(hù)雜志, 2009, 09(5): 492-494. doi: 復(fù)制
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| 7. | ·493· ? 2002-2009 Editorial Department of Chinese Journal of Respiratory and Critical Care Medicine. All rights reserved. Http://www.cjrccm.com medicine: best BETs from the Manchester Royal Infirmary. Bet 1 . Lactate clearance a better predictor of mortality than initial lactate level lactate clearance a better predictor of mortality than initial lactate level. Emerg Med J, 2008, 25: 593-594. |
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| 12. | Voves C, Wuillemin WA, Zeerleder S. International Society on Thrombosis and Haemostasis score for overt disseminated intravascular coagulation predicts organ dysfunction and fatality in sepsis patients. Blood Coagul Fibrin Olysis, 2006, 17: 445-451. |
| 13. | Bernard GR, Vincent JL, Laterre PF, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med, 2001, 344: 699-709. |
| 14. | SCCM/ESICM/ACCP/ ATS /SIS international sepsis definitions conference. Crit Care Med, 2003, 31: 1250-1256. |
- 1. Levy MM, Fink MP, Marshall JC, et al.
- 2. James JH, Luchette FA, Mccarter FD, et al. Lactate is an unreliable indicator of tissue hypoxia in injury or sepsis. Lancet, 1999, 354 : 505-508.
- 3. Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med, 2004 , 32 : 1637-1642.
- 4. 管向東, 寇秋野. 感染性休克血流動(dòng)力學(xué)的監(jiān)測(cè)指標(biāo). 創(chuàng)傷外科雜志, 2007, 8: 97-99.
- 5. Gando S, Nanzaki S, Sasaki S, et al. Activation of the extrinsic coagulation pathway in patients with severe sepsis and septic shock. Crit Care Med, 1998, 26: 2005-2009.
- 6. 王曉芝, 呂長俊, 高福全, 等. 目標(biāo)指導(dǎo)下治療膿毒性休克的療效觀察. 中國危重病急救醫(yī)學(xué), 2006, 18, 661-664.
- 7. ·493· ? 2002-2009 Editorial Department of Chinese Journal of Respiratory and Critical Care Medicine. All rights reserved. Http://www.cjrccm.com medicine: best BETs from the Manchester Royal Infirmary. Bet 1 . Lactate clearance a better predictor of mortality than initial lactate level lactate clearance a better predictor of mortality than initial lactate level. Emerg Med J, 2008, 25: 593-594.
- 8. Corley KT, Donaldson LL, Furr MO. Arterial lactate concentration, hospital survival, sepsis and SIRS in critically ill neonatal foals. Equine Vet J, 2005, 37 : 53 -59.
- 9. Gnanasegaram D, Hugher N. Towards evidence based emergenay 中國呼吸與危重監(jiān)護(hù)雜志2009 年9 月第8 卷第5 期Chin J Respir Crit Care Med, September 2009, Vol.
- 10. , No.
- 11. 齊云曉, 劉敏涓, 葉絮, 等. 膿毒癥患者血栓前體蛋白測(cè)定的臨床價(jià)值探討. 血栓與止血學(xué), 2008, 14: 105-107.
- 12. Voves C, Wuillemin WA, Zeerleder S. International Society on Thrombosis and Haemostasis score for overt disseminated intravascular coagulation predicts organ dysfunction and fatality in sepsis patients. Blood Coagul Fibrin Olysis, 2006, 17: 445-451.
- 13. Bernard GR, Vincent JL, Laterre PF, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med, 2001, 344: 699-709.
- 14. SCCM/ESICM/ACCP/ ATS /SIS international sepsis definitions conference. Crit Care Med, 2003, 31: 1250-1256.