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目的:探讨早期动脉血乳酸清除率对脓毒症休克患者预后的评估,与APACHEⅡ评分、SOFA评分的比较。方法:回顾性收集我科室2015-07-2016-08期间78例感染性休克患者的临床资料,根据患者住院28d转归,将患者分为生存组和死亡组。根据ROC曲线,分析6h动脉血乳酸清除率,寻找出最佳截断值,根据最佳截断值分为高乳酸清除率组及低乳酸清除率组,分析2组乳酸、APACHEⅡ评分、SOFA评分及病死率之间的差异。结果:研究收集78例感染性休克患者,其中存活44例,死亡34例。存活组和死亡组:入院动脉血乳酸水平、APACHEⅡ评分、SOFA评分及早期乳酸清除率差异均有统计学意义(P<0.05)。早期乳酸清除率、APACHEⅡ评分及SOFA评分ROC曲线下面积分别为0.649、0.793、0.881。最高约登指数0.60时,对应的早期乳酸清除率为29%时,以此分为高乳酸清除率组和低乳酸清除率组,2组APACHEⅡ评分、SOFA评分及预后差异均有统计学意义(P<0.01)。结论:早期乳酸清除率可作为判断感染性休克患者预后的指标。
Objective: To investigate the prognosis of septic shock patients with early arterial lactate clearance rate, and compare with APACHE Ⅱ score and SOFA score. Methods: The clinical data of 78 patients with septic shock in our department during 2015-07-2016-08 were retrospectively collected. Patients were divided into survival group and death group according to 28 days of hospitalization. According to the ROC curve, the lactic acid clearance rate of 6h arterial blood was analyzed to find out the best cut-off value. According to the optimal cut-off value, the lactic acid clearance rate and the low lactic acid clearance rate were calculated. The lactic acid, APACHEⅡscore, The difference between rates. Results: The study collected 78 patients with septic shock, of which 44 patients survived and 34 died. Survival group and death group: arterial blood lactate levels, APACHE Ⅱ score, SOFA score and early lactic acid clearance rate differences were statistically significant (P <0.05). The area under the ROC curve of early lactic acid clearance rate, APACHEⅡscore and SOFA score were 0.649,0.793,0.881 respectively. The maximum Roughness index was 0.60, corresponding to the early lactic acid clearance rate of 29%, which was divided into high lactic acid clearance group and low lactic acid clearance group, two groups APACHE Ⅱ score, SOFA score and prognosis were statistically significant (P < P <0.01). Conclusion: Early lactic acid clearance can be used as an index to judge the prognosis of septic shock patients.