早期乳酸面积与成人脓毒症患者预后相关性的研究

发布时间：2018-01-18 11:24

本文关键词：早期乳酸面积与成人脓毒症患者预后相关性的研究　出处：《河南科技大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过对脓毒症患者入院后24小时内的动脉血乳酸水平进行动态监测,分析早期乳酸面积与脓毒症患者病情严重程度和预后的相关性及其临床意义。方法:采用单中心、前瞻性研究的方法,选取2015年9月至2016年12月河南科技大学第一附属医院急诊重症监护病房收治的符合纳入及排除标准的成人脓毒症患者进行研究。收集入组患者基本临床资料并动态监测生命体征变化。所有入组患者分别于入院时采集静脉血行血常规、血凝、肝肾功能等实验室检测。于入院时和入院第6、12、18、24小时采集动脉血行动脉血气分析。利用所记录血气分析结果中动脉血乳酸浓度数据及采血时间,根据乳酸清除率计算公式对6小时乳酸清除率进行计算。将动脉血乳酸浓度-时间数据以(x=时间,y=乳酸浓度)标记于平面直角坐标系中,以直线连接各点,利用梯形面积计算公式分别计算0-6h、6-12h、12-18h、18-24h的“浓度-时间”下面积。将以上结果进行求和从而得出各入组患者入院后第1个24小时内的早期乳酸面积。根据所记录生命体征和检测指标的最差值对患者入院第1天的APACHEⅡ和SOFA评分进行计算。所有患者均按照脓毒症治疗的相关指南的推荐进行综合治疗。依据随访28天的生存情况,将所有入组患者分为存活组和死亡组。比较存活组与死亡组之间基本临床资料、血常规、肝肾功能、入院初始乳酸浓度、6小时早期乳酸清除率、入院第1个24小时的早期乳酸面积、APACHEⅡ评分、SOFA评分的差异。分析入院初始乳酸浓度、6小时乳酸清除率、早期乳酸面积与APACHEⅡ评分、SOFA评分之间的相关性。应用Logistic回归分析,对包括上述入院时乳酸浓度、早期乳酸面积、APACHEⅡ评分等预后相关因素进行分析。绘制ROC曲线对早期乳酸面积、APACHEⅡ评分等与脓毒症患者预后相关性进行评估。结果:共纳入120例患者,其中男性66例,女性54例。研究结果显示:1.存活组与死亡组患者入院初始乳酸浓度、6小时早期乳酸清除率、早期乳酸面积、APACHEⅡ评分、SOFA评分之间存在统计学差异(P0.05)。2.Speraman相关分析的结果显示:初始乳酸浓度与APACHEⅡ评分、SOFA评分呈正相关(r值分别为0.659、0.634,P值均0.05);早期乳酸面积与APACHEⅡ评分、SOFA评分呈正相关(r值分别为0.716、0.751,P值均0.05);6小时乳酸清除率与APACHEⅡ评分、SOFA评分呈负相关(r值分别为-0.726、-0.691,P值均0.05)。3.Logistic回归分析结果显示:入院初始乳酸浓度、6小时早期乳酸清除率、早期乳酸面积、APACHEⅡ评分、SOFA评分均为脓毒症患者预后的生存危险因素。上述指标的ROC曲线下面积分别为0.727、0.766、0.936、0.829和0.817。结论:1.乳酸浓度及其动态变化与脓毒症患者的预后相关。2.入院初始乳酸浓度、6小时乳酸清除率、早期乳酸面积、APACHEⅡ评分和SOFA评分均可作为脓毒症患者预后判断的生存危险因素,其中以早期乳酸面积为最优。3.早期乳酸面积可作为预测成人脓毒症患者预后的良好工具应用于临床。
[Abstract]:Objective: to conduct dynamic monitoring of arterial blood lactate level within 24 hours of admission of patients with sepsis, correlation analysis of early lactate area of patients with sepsis severity and prognosis of the disease and its clinical significance. Methods: a single center, prospective study method, study met the inclusion and exclusion criteria for adult sepsis patients with sepsis selected the First Affiliated Hospital of Henan University of Science and Technology from September 2015 to December 2016 in EICU were collected into groups of patients. The basic clinical data and dynamic monitoring of vital signs. All the patients were respectively on admission blood collection and blood routine examination, blood coagulation, liver and kidney function in laboratory. From the analysis and on the 6,12,18,24 hours arterial blood arterial blood gas at the time of admission. The record of arterial blood gas analysis results in the concentration of lactic acid and lactic acid according to the data collection time, The clearance rate calculation formula to calculate the 6 hour lactic acid clearance rate. The arterial blood lactate concentration time data in (x=, y= lactic acid concentration) markers in plane Cartesian coordinate system, the lines connecting the points, calculation formulas were calculated by 0-6h, 6-12h 12-18h, "trapezoid area, concentration time 18-24h the area under the above results were obtained for the early lactate area of each patients within 24 hours after admission in first. According to the difference of the record vital signs and indexes of patients admitted to hospital first days of APACHE II and SOFA score were calculated. All the patients were in accordance with the relevant guidelines for the treatment of sepsis the recommended treatment. Based on the survival situation during 28 days of follow-up, all patients were divided into survival group and death group. Comparison between the survival group and death group the basic clinical data, blood routine, liver and kidney function, the initial admission of lactic acid The concentration of 6 hours early lactate clearance rate, hospitalization first 24 hours early lactic acid area, APACHE score, SOFA score difference. The initial concentration of lactic acid were analyzed, 6 hour lactic acid clearance rate, early lactate area and APACHE score, SOFA score. The correlation between the application of Logistic regression analysis, including the admission of the concentration of lactic acid and lactic acid in early area, relevant factors and prognosis of APACHE score analysis. ROC curve of early lactate area, APACHE score to evaluate the prognosis of patients with sepsis correlation. Results: 120 patients were included, of which 66 were male, 54 were female. The results showed: 1. survival group and the death of patients the initial concentration of lactic acid, 6 hours early lactate clearance rate, early lactate area, APACHE score, there was significant difference between the score of SOFA (P0.05).2.Speraman correlation analysis showed that: The initial concentration of lactate and APACHE score, SOFA score was positively correlated (r = 0.659,0.634, P value was 0.05); the early lactate area and APACHE score, SOFA score was positively correlated (r = 0.716,0.751, P value was 0.05); 6 hour lactic acid clearance rate and APACHE score, SOFA score was negative correlation (r = -0.726, -0.691, P 0.05).3.Logistic regression analysis showed that the initial concentration of lactic acid in 6 hours of admission, early lactate clearance rate, early lactate area, APACHE score, SOFA score for the prognosis of patients with sepsis survival risk factors. The above indexes under ROC curve area 0.727,0.766,0.936,0.829 and 0.817. respectively. Conclusion: the changes of 1. lactic acid concentration and dynamic sepsis and prognosis of admission to the.2. initial concentration of lactic acid, 6 hour lactic acid clearance rate, early lactate area, APACHE score and SOFA score can be used as sepsis Survival risk factors for prognosis of patients, including early lactate area as the best.3., early lactate area, can be used as a good tool to predict the prognosis of adult sepsis.

【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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