| 张骏.乳酸水平对休克患者容量反应性及预后的预测价值[J].浙江中西医结合杂志,2019,29(10): |
| 乳酸水平对休克患者容量反应性及预后的预测价值 |
| Volume Responsiveness of Lactic Acid Level to Shock Patients and Its Predictive Value for Prognosis |
| 投稿时间：2019-03-01 修订日期：2019-04-10 |
| DOI： |
| 中文关键词: 乳酸 容量反应性 感染性休克 预后 |
| 英文关键词:Lactic acid Volume responsiveness Septic shock Prognosis |
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| 中文摘要: |
| 目的：探讨乳酸（LAC）水平对休克患者容量反应性，并分析其对患者预后的预测价值。方法：选取2017年8月至2018年9月本院收治的45例感染性休克患者为研究对象，所有患者均进行被动抬腿试验（PLR），之后进行容量负荷试验（VE）。采用VE评估容量反应性，根据VE前后心脏指数（CI）结果将患者分为阳性组（27例）与阴性组（18例）。同时对所有患者进行随访，根据患者生存情况分为生存组（35例）与死亡组（10例）。采用全自动生化仪测定仪检测血LAC水平；脉搏指示连续心排量（PiCCO）检测心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、脉压（PP）、每搏量变异率（SVV）、心排量（CO）等血流动力学指标。受试者工作特征曲线（ROC）分析LAC水平变化对VE容量反应的有效性；Logistic法分析影响感染性休克患者预后的相关因素。结果：与VE反应后阴性组相比，阳性组CO显著升高（P＜0.05），而SVV与LAC水平均显著降低（P＜0.05），其他各参数比较差异均无统计学意义（P＞0.05）；与阴性组相比，阳性组△CO与△LAC值均显著升高（P＜0.05）。ROC分析显示△LAC对VE反应的敏感度为88.89%，特异度为77.78%。生存组CO显著高于死亡组（P＜0.05），而CVP、SVV、LAC均显著降低（P＜0.05）。Logistic分析显示LAC水平为影响感染性休克患者预后的危险因素。结论：LAC水平可用于评估感染性休克患者容量反应性，并对患者预后评估具有一定预测价值。 |
| 英文摘要: |
| Objective: To investigate the volume responsiveness of lactic acid (LAC) level in shock patients and to analyze its predictive value for prognosis. Methods: From August 2017 to September 2018, 45 patients with septic shock admitted to our hospital were selected as the subjects, all patients underwent passive leg raising test (PLR), and then underwent volume expansion test (VE). Volume responsiveness was assessed by VE, and patients were divided into positive group (27 cases) and negative group (18 cases) according to the results of cardiac index (CI) before and after VE. All patients were followed-up and divided into survival group (35 cases) and death group (10 cases) according to the survival. The blood LAC level was detected by automatic biochemical analyzer; heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), pulse pressure (PP), pulse volume variability (SVV), cardiac output (CO) and other hemodynamic parameters were measured by pulse indicator continuous cardiac output (PiCCO). Receiver operating characteristic curve (ROC) was used to analyze the effectiveness of LAC level change on VE volume response; Logistic method was used to analyze the factors related to the prognosis of septic shock patients. Results: Compared with VE negative group, CO in positive group increased significantly (P < 0.05), while SVV and LAC levels decreased significantly (P < 0.05), and there was no significant difference in other parameters (P > 0.05); compared with the negative group, the values of △CO and △LAC in the positive group were significantly increased (P < 0.05). ROC analysis showed that the sensitivity of △LAC to VE reaction was 88.89% and the specificity was 77.78%. the CO of survival group was significantly higher than that of the death group (P < 0.05), while CVP, SVV and LAC were significantly lower (P < 0.05); Logistic analysis showed that LAC level was a risk factor for the prognosis of septic shock patients. Conclusion: LAC level can be used to assess the volume responsiveness of septic shock patients and it has a certain predictive value for the prognostic evaluation of patients. |
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