• 曲靖市第一人民醫(yī)院ICU科（云南曲靖，655000）;

【摘要】　目的　 評(píng)估乳酸清除率與重癥創(chuàng)傷患者預(yù)后的關(guān)系。　方法　 回顧性分析2010年1－6月收住曲靖市第一人民醫(yī)院ICU科的37例重癥創(chuàng)傷患者的初始血乳酸值、第2次血乳酸值、乳酸清除率及患者的預(yù)后，將患者分為存活組和死亡組，比較兩組患者初始血乳酸值、乳酸清除率的差異。　結(jié)果　 兩組患者年齡、性別、初始血乳酸值差異無統(tǒng)計(jì)學(xué)意義（P gt;0.05）。存活組血乳酸清除率（48.26±21.57）%明顯高于死亡組（11.71±20.88）%，差異有統(tǒng)計(jì)學(xué)意義（P lt;0.001）；當(dāng)乳酸清除率≥13%時(shí)，能較好地預(yù)測患者生存，其靈敏度為96%，特異度為80%。　結(jié)論　 乳酸清除率可用于評(píng)估重癥創(chuàng)傷患者的預(yù)后。
【Abstract】　Objective　 To evaluate the correlation between prognosis and lactate clearance in severe trauma.　Methods　 The clinical data of 37 patients with severe trauma admitted between January and June 2010 in the First People′s Hospital of Qujin were analyzed retrospectively. These data included initial blood lactate concentration, second blood lactate concentration, lactate clearance rate, and prognosis of the patients. The patients were divided into survivor group and non-survivor group, and the differences of initial blood lactate concentration and lactate clearance rate between them were compared.　Results　 There were no differences in age, sex, and the initial blood lactate concentration (P gt;0.05) between the two groups. Compared with non-survivors, the survivors had a significantly higher lactate clearance [(48.26±21.57)% vs. (11.71±20.88)%, P lt;0.001]. Patients with a lactate clearance higher than or equal to 13% had a sensitivity of 96%, specificity of 80%, for predicting survival.　Conclusion　 Lactate clearance rate can be used to predict the prognosis of severe trauma.

引用本文： 李曦,嚴(yán)永俊,劉世盛,李銳,鄧?yán)^延,劉國鋒. 乳酸清除率評(píng)估重癥創(chuàng)傷患者預(yù)后的臨床研究. 華西醫(yī)學(xué), 2011, 26(8): 1139-1141. doi: 復(fù)制

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2. 　Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial[J]. JAMA, 2010, 303(8): 739-746.
3. 　Jansen TC, van Bommel J, Woodward R, et al. Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: a retrospective observational study[J]. Crit Care Med, 2009, 37(8): 2369-2374.
4. 　Jeng JC, Jablonski K, Bridgeman A, et al. Serum lactate, not base deficit, rapidly predicts survival after major burns[J]. Burns, 2002, 28(2): 161-166.
5. 　Smith I, Kumar P, Molloy S, et al. Base excess and lactate as prognostic indicators for patients admitted to intensive care[J]. Intensive Care Med, 2001, 27(1): 74-83.
6. 　Basaran M, Sever K, Kafali E, et al. Serum lactate level has prognostic significance after pediatric cardiac surgery[J]. J Cardiothorac Vasc Anesth, 2006, 20(1): 43-47.
7. 　del Portal DA, Shofer F, Mikkelsen ME, et al. Emergency department lactate is associated with mortality in older adults admitted with and without infections[J]. Acad Emerg Med, 2010, 17(3): 260-268.
8. 　Aslar AK, Kuzu MA, Elhan AH, et al. Admission lactate level and the APACHE Ⅱ score are the most useful predictors of prognosis following torso trauma[J]. Injury, 2004, 35(8): 746-752.
9. 　Husain FA, Martin MJ, Mullenix PS, et al. Serum lactate and base deficit as predictors of mortality and morbidity[J]. Am J Surg, 2003, 185(5): 485-491.
10. 　Lavery RF, Livingston DH, Tortella BJ, et al. The utility of venous lactate to triage injured patients in the trauma center[J]. J Am Coll Surg, 2000, 190(6): 656-664.
11. 　Khosravani H, Shahpori R, Stelfox HT, et al. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill[J]. Crit Care, 2009, 13(3): R90.
12. 　Jansen TC, van Bommel J, Mulder PG, et al. The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study[J]. Crit Care, 2008, 12(6): R160.
13. 　徐向東, 吳健鋒, 管向東, 等. 早期乳酸清除率評(píng)估外科嚴(yán)重膿毒癥預(yù)后的臨床價(jià)值研究[J]. 中國實(shí)用外科雜志, 2007, 27(12): 969-970.
14. 　Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock[J]. Crit Care Med, 2004, 32(8): 1637-1642.
15. 　Arnold RC, Shapiro NI, Jones AE, et al. Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis[J]. Shock. 2009, 32(1): 35-39.
16. 　Blow O, Magliore L, Claridge JA, et al. The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma[J]. J Trauma, 1999, 47(5): 964-969.
  1. 1. 　De Backer D. Lactic acidosis[J]. Intensive Care Med, 2003, 29(5): 699-702.
  2. 2. 　Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial[J]. JAMA, 2010, 303(8): 739-746.
  3. 3. 　Jansen TC, van Bommel J, Woodward R, et al. Association between blood lactate levels, Sequential Organ Failure Assessment subscores, and 28-day mortality during early and late intensive care unit stay: a retrospective observational study[J]. Crit Care Med, 2009, 37(8): 2369-2374.
  4. 4. 　Jeng JC, Jablonski K, Bridgeman A, et al. Serum lactate, not base deficit, rapidly predicts survival after major burns[J]. Burns, 2002, 28(2): 161-166.
  5. 5. 　Smith I, Kumar P, Molloy S, et al. Base excess and lactate as prognostic indicators for patients admitted to intensive care[J]. Intensive Care Med, 2001, 27(1): 74-83.
  6. 6. 　Basaran M, Sever K, Kafali E, et al. Serum lactate level has prognostic significance after pediatric cardiac surgery[J]. J Cardiothorac Vasc Anesth, 2006, 20(1): 43-47.
  7. 7. 　del Portal DA, Shofer F, Mikkelsen ME, et al. Emergency department lactate is associated with mortality in older adults admitted with and without infections[J]. Acad Emerg Med, 2010, 17(3): 260-268.
  8. 8. 　Aslar AK, Kuzu MA, Elhan AH, et al. Admission lactate level and the APACHE Ⅱ score are the most useful predictors of prognosis following torso trauma[J]. Injury, 2004, 35(8): 746-752.
  9. 9. 　Husain FA, Martin MJ, Mullenix PS, et al. Serum lactate and base deficit as predictors of mortality and morbidity[J]. Am J Surg, 2003, 185(5): 485-491.
  10. 10. 　Lavery RF, Livingston DH, Tortella BJ, et al. The utility of venous lactate to triage injured patients in the trauma center[J]. J Am Coll Surg, 2000, 190(6): 656-664.
  11. 11. 　Khosravani H, Shahpori R, Stelfox HT, et al. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill[J]. Crit Care, 2009, 13(3): R90.
  12. 12. 　Jansen TC, van Bommel J, Mulder PG, et al. The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study[J]. Crit Care, 2008, 12(6): R160.
  13. 13. 　徐向東, 吳健鋒, 管向東, 等. 早期乳酸清除率評(píng)估外科嚴(yán)重膿毒癥預(yù)后的臨床價(jià)值研究[J]. 中國實(shí)用外科雜志, 2007, 27(12): 969-970.
  14. 14. 　Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock[J]. Crit Care Med, 2004, 32(8): 1637-1642.
  15. 15. 　Arnold RC, Shapiro NI, Jones AE, et al. Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis[J]. Shock. 2009, 32(1): 35-39.
  16. 16. 　Blow O, Magliore L, Claridge JA, et al. The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma[J]. J Trauma, 1999, 47(5): 964-969.