论文部分内容阅读
目的:探讨动脉血乳酸清除率、降钙素原(PCT)与脓毒症患者预后的评估价值。方法:回顾性分析2011-10-2014-10入住我院重症医学科的120例脓毒症患者临床资料,入院24h内行PCT及初始乳酸(入科时监测)和6h的血乳酸水平监测,计算6h乳酸清除率、APACHEⅡ评分,并比较死亡组患者和存活组患者乳酸清除率、PCT及APACHEⅡ评分的差异,比较不同APACHEⅡ评分分层组间PCT及6h乳酸清除率的差异,对APACHEⅡ评分、PCT、6h乳酸清除率进行相关性分析;绘制受试者工作特征曲线(ROC);评价PCT、6h乳酸清除率对脓毒症患者预后的评估价值。结果:死亡组患者入院时PCT、APACHEⅡ评分明显高于存活组患者,6h乳酸清除率明显低于存活组,差异有统计学意义(P<0.01);乳酸清除率、PCT在不同APACHEⅡ评分分层组间两两比较差异均有统计学意义(P<0.01);经过Spearman相关性分析入院患者6h血乳酸清除率与APACHEⅡ评分呈显著负相关(P<0.01),且随着APACHEⅡ评分的升高,动脉血6h乳酸清除率明显降低,PCT与APACHEⅡ评分呈显著正相关(P<0.01)。6h乳酸清除率预测患者28d病死率的ROC曲线下面积(AUC)为0.93±0.03(95%CI:0.87~0.99),截断值为18.64%,灵敏度82.86%,特异度95.56%,Youden指数0.784;PCT预测患者28d病死率的AUC为0.79±0.05(95%CI:0.68~0.89),截断值为7.78ng/ml,灵敏度79.41%,特异度70.37%,Youden指数0.498。结论:动脉血血乳酸清除率联合PCT可作为判断脓毒症患者病情和预后的重要监测指标。
Objective: To evaluate the prognostic value of arterial lactate clearance, procalcitonin (PCT) and sepsis. Methods: The clinical data of 120 sepsis patients admitted to our department of critical care from 2011-10-2014-10 were retrospectively analyzed. The PCT and initial lactic acid (monitored during enrollment) and the blood lactic acid 6h lactic acid clearance rate and APACHEⅡscore, and lactic acid clearance rate, PCT and APACHEⅡscore difference between death group and survival group were compared. The differences of PCT and 6h lactic acid clearance between different APACHEⅡscore stratified groups were compared. APACHEⅡscore, PCT , 6h lactic acid clearance rate; draw the receiver operating characteristic curve (ROC); evaluation of PCT, 6h lactate clearance rate of sepsis prognosis evaluation. Results: The PCT and APACHEⅡ scores of patients in the death group were significantly higher than those of the surviving patients, and the lactic acid clearance rate at 6 hours was significantly lower than that of the survival group (P <0.01) (P <0.01). Spearman’s correlation analysis showed that there was a significant negative correlation between serum lactate clearance rate and APACHEⅡ score at 6h (P <0.01), and with the increase of APACHEⅡ score , Arterial blood 6h lactic acid clearance decreased significantly, PCT and APACHE Ⅱ score was positively correlated (P <0.01). The area under the ROC curve (AUC) of 6 h lactate clearance rate was 0.93 ± 0.03 (95% CI: 0.87 ~ 0.99), the cutoff value was 18.64%, the sensitivity was 82.86%, the specificity was 95.56% and the Youden index was 0.784. The AUC of PCT 28d mortality was 0.79 ± 0.05 (95% CI: 0.68 ~ 0.89), the cutoff was 7.78ng / ml, the sensitivity was 79.41%, the specificity was 70.37%, the Youden index was 0.498. Conclusion: Arterial blood lactic acid clearance combined with PCT can be used as an important indicator to evaluate the condition and prognosis of patients with sepsis.